Basic Information
Provider Information | |||||||||
NPI: | 1255738258 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RAJASEKARAN RATHNAKUMAR | ||||||||
FirstName: | GEETHAPRIYA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4371 VERONICA S SHOEMAKER BLVD | ||||||||
Address2: |   | ||||||||
City: | FORT MYERS | ||||||||
State: | FL | ||||||||
PostalCode: | 339162216 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2392748200 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 8763 RIVER CROSSING BLVD | ||||||||
Address2: |   | ||||||||
City: | NEW PORT RICHEY | ||||||||
State: | FL | ||||||||
PostalCode: | 346551112 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7278428411 | ||||||||
FaxNumber: | 8779172336 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/19/2014 | ||||||||
LastUpdateDate: | 04/08/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/28/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 291893 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 390200000X | 291893 | NY | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207R00000X | ME148496 | FL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RH0000X | ME148496 | FL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RX0202X | 0101274398 | VA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RX0202X | ME148496 | FL | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No ID Information.