Basic Information
| Provider Information | |||||||||
| NPI: | 1720178296 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PALVADI | ||||||||
| FirstName: | RAJA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1709 DRYDEN RD | ||||||||
| Address2: | SUITE 1700, MS: BCM:120 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137987356 | ||||||||
| FaxNumber: | 7137986374 | ||||||||
| Practice Location | |||||||||
| Address1: | 1709 DRYDEN RD | ||||||||
| Address2: | SUITE 1700, MS: BCM120 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137988786 | ||||||||
| FaxNumber: | 7137986374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 09/18/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 42182 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 142942001 | 05 | AR | MEDICAID |