Basic Information
| Provider Information | |||||||||
| NPI: | 1083889703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIVI | ||||||||
| FirstName: | RAJA RAJESWARI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5410 MARYLAND WAY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153775600 | ||||||||
| FaxNumber: | 6153735280 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 11TH ST | ||||||||
| Address2: | COGENT HEALTHCARE OF TEXAS, PA | ||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763014300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9407643983 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2008 | ||||||||
| LastUpdateDate: | 08/20/2010 | ||||||||
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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 | 207R00000X | N3621 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00834995 | 01 | TX | RR MEDICARE | OTHER | 207455101 | 05 | TX | MEDICAID | 8X9809 | 01 | TX | BCBS | OTHER |