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NPI Code Detail

MEDICARE: DR. RADHIKA DASARAJU M.D

MEDICARE: DR. RADHIKA DASARAJU 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
1208000000XPediatrics Physician125053608IL
2208000000XPediatrics PhysicianME152421FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902033954
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RADHIKA DASARAJU M.D
Provider Business Mailing Address
First Line : 14015 EGRET TOWER DR
Second Line :
City : ORLANDO
State : FL
Zip : 32837-6197
Country : US
Telephone Number : 407-447-7100
Fax Number : 407-447-6100
Provider Business Practice Location Address
First Line : 849 GREENWAY PROFESSIONAL CT
Second Line :
City : ORLANDO
State : FL
Zip : 32824-9482
Country : US
Telephone Number : 407-905-8827
Fax Number : 407-660-1667
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2009
Last Update Date : 06/13/2024

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