Healthcare Provider Details

I. General information

NPI: 1326042250
Provider Name (Legal Business Name): RAJESWARI GUNDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

1400 E 2ND ST
DEFIANCE OH
43512-2440
US

IV. Provider business mailing address

1400 E 2ND ST
DEFIANCE OH
43512-2440
US

V. Phone/Fax

Practice location:
  • Phone: 419-783-3344
  • Fax: 419-783-2793
Mailing address:
  • Phone: 419-783-3344
  • Fax: 419-783-2793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35056652
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: