Provider Demographics
NPI:1831259381
Name:VADHERA, RAKESH B (MBBS)
Entity type:Individual
Prefix:
First Name:RAKESH
Middle Name:B
Last Name:VADHERA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:RAKESH
Other - Middle Name:B
Other - Last Name:VADHERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MBBS
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-5302
Mailing Address - Country:US
Mailing Address - Phone:409-772-2222
Mailing Address - Fax:
Practice Address - Street 1:400 HARBORSIDE DR
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0001
Practice Address - Country:US
Practice Address - Phone:409-772-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4282207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX050071423OtherRR MCR PTAN
TX042951601Medicaid
TX050071423OtherRR MCR PTAN
TXF12717Medicare UPIN