Healthcare Provider Details

I. General information

NPI: 1073576005
Provider Name (Legal Business Name): SRIDHAR RAJAMANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S AVE A
YUMA AZ
85364-7127
US

IV. Provider business mailing address

PO BOX 6935
YUMA AZ
85366-6935
US

V. Phone/Fax

Practice location:
  • Phone: 928-317-9100
  • Fax:
Mailing address:
  • Phone: 928-317-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number29371
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD60693
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME132789
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number36143759
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number29371
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC53701
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD60693
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number108064
License Number StateMT
# 9
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD61113560
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: