Basic Information
Provider Information
NPI: 1285652925
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALAGUGURUSAMY
FirstName: RAJKUMAR
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11511 SHADOW CREEK PKWY
Address2:  
City: PEARLAND
State: TX
PostalCode: 775847298
CountryCode: US
TelephoneNumber: 7134420000
FaxNumber:  
Practice Location
Address1: 2515 BUSINESS CENTER DR
Address2:  
City: PEARLAND
State: TX
PostalCode: 775842294
CountryCode: US
TelephoneNumber: 7134427200
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/18/2006
LastUpdateDate: 03/31/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/31/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XM3447TXY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
20277320105TX MEDICAID


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