MEDICARE: PADMINI G RAJAN M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME0049009	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04502	OTHER	FL	BLUE CROSS/BLUE SHEILD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	10718522	OTHER		CAQH

General Provider Information

NPI Number	:	1588626584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PADMINI G RAJAN M.D

Provider Business Mailing Address
First Line	:	300 RIVERSIDE DR E
Second Line	:	STE 3900
City	:	BRADENTON
State	:	FL
Zip	:	34208-1097
Country	:	US
Telephone Number	:	941-748-4847
Fax Number	:	941-748-4827

Provider Business Practice Location Address
First Line	:	712 53RD AVE E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34203-5827
Country	:	US
Telephone Number	:	941-755-2456
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	11/04/2020

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