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General NPI Number Information
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NPI Number | 1386098283
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Entity Type | Organization
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Legal Business Name | BHARATH G RAJ
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Dates
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Enumeration Date | 04/17/2016
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 3411 CEDAR KNOLLS DR STE B
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City | KINGWOOD
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State | TX
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Zip | 77339-2474
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Country | US
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Telephone | 281-532-5462
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Fax | 877-796-5317
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Provider Business Mailing Address
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Address Line | 3411 CEDAR KNOLLS DR STE B
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City | KINGWOOD
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State | TX
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Zip | 77339-2474
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Country | US
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Telephone | 281-532-5462
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Fax | 877-796-5317
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | BHARATH GURURAJ RAJ
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Credential | MD
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Telephone | 832-410-4602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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