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General NPI Number Information
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NPI Number | 1710113253
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Entity Type | Individual
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Provider Name | SHANKAR RAJESWARAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 08/20/2020
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Provider Practice Location Address
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Address Line | 3401 CIVIC CENTER BLVD DIVISION OF RADIOLOGY
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4319
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Country | US
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Telephone | 215-590-1190
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Fax | 215-590-4668
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Provider Business Mailing Address
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Address Line | 2021 CHESTNUT STREET APT 705
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City | PHILADELPHIA
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State | PA
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Zip | 19103
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Country | US
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Telephone | 610-453-2913
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036-130483
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | MT196869
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License Number State | PA
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