Basic Information
| Provider Information | |||||||||
| NPI: | 1609803956 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUDRARAJU | ||||||||
| FirstName: | MADHAVI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8109 FREDERICKSBURG RD | ||||||||
| Address2: | PHYSICIAN PRACTICE SERVICES | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105758514 | ||||||||
| FaxNumber: | 2105758004 | ||||||||
| Practice Location | |||||||||
| Address1: | 8201 EWING HALSELL DR | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105758514 | ||||||||
| FaxNumber: | 2105758004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 02/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | N5374 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RI0008X | N5374 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology | 207RT0003X | N5374 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology |
ID Information
| ID | Type | State | Issuer | Description | 219652902 | 01 | TX | CSHCN | OTHER | 8CJ296 | 01 | TX | BCBS | OTHER | P00996225 | 01 | MEDICARE RAILROAD | OTHER | 219652901 | 05 | TX | MEDICAID |