Provider Demographics
NPI:1982786562
Name:SHANTHARAM, RAJALAKSHMI V (MD)
Entity type:Individual
Prefix:DR
First Name:RAJALAKSHMI
Middle Name:V
Last Name:SHANTHARAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAJALAKSHMI
Other - Middle Name:
Other - Last Name:VENKATESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2723 S 7TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3558
Mailing Address - Country:US
Mailing Address - Phone:812-238-1730
Mailing Address - Fax:
Practice Address - Street 1:1530 N 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1057
Practice Address - Country:US
Practice Address - Phone:812-242-9631
Practice Address - Fax:812-242-9647
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062513207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000822184OtherANTHEM
IN200846250Medicaid
IN200846250Medicaid