Basic Information
| Provider Information | |||||||||
| NPI: | 1659665305 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RADHAKRISHNAN | ||||||||
| FirstName: | GEETHA | ||||||||
| MiddleName: | LAKSHMI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RAMASWAMY | ||||||||
| OtherFirstName: | GEETHA | ||||||||
| OtherMiddleName: | LAKSHMI | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 301 UNIVERSITY BLVD | ||||||||
| Address2: | UTMB CHILDREN'S HOSPITAL 3.230 | ||||||||
| City: | GALVESTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775550354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097470534 | ||||||||
| FaxNumber: | 4097470721 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 UNIVERSITY BLVD | ||||||||
| Address2: | UTMB CHILDREN'S HOSPITAL 3.230 | ||||||||
| City: | GALVESTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775550354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097470534 | ||||||||
| FaxNumber: | 4097470721 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2011 | ||||||||
| LastUpdateDate: | 05/29/2011 | ||||||||
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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 | 208000000X | BP1-0040962 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.