Provider Demographics
NPI:1679528467
Name:GOGIA, RAJESH (MD)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:GOGIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 E SOUTHLAKE BLVD
Mailing Address - Street 2:STE L-309
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6516
Mailing Address - Country:US
Mailing Address - Phone:214-502-8157
Mailing Address - Fax:972-739-1468
Practice Address - Street 1:3025 MATLOCK RD
Practice Address - Street 2:STE 100
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2902
Practice Address - Country:US
Practice Address - Phone:214-502-8157
Practice Address - Fax:972-739-1468
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM57242085R0202X
GA0574642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00670157OtherMEDICARE RAILROAD
GA147305774CMedicaid
GA147305774CMedicaid
TXP00670157OtherMEDICARE RAILROAD
TXTXB105532Medicare PIN