Provider Demographics
NPI:1962517516
Name:PADMANABHAN, RAJESH S (MD)
Entity type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:S
Last Name:PADMANABHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2006
Mailing Address - Country:US
Mailing Address - Phone:817-466-7400
Mailing Address - Fax:817-465-6582
Practice Address - Street 1:3215 OMEGA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2006
Practice Address - Country:US
Practice Address - Phone:817-466-7400
Practice Address - Fax:817-465-6582
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0209208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4324375OtherBLUE LINK ID (BCBS)
TX2490792OtherUHC PROVIDER NO.
TX1424679OtherCIGNA PROVIDER NO.
TX7824629OtherAETNA PROVIDER NO.
TX178434001Medicaid
TX0090MBOtherBCBS PROVIDER NO.
TX178434001Medicaid
0090MBMedicare PIN