| Doctor Name: | ANANDA SELVARAJ |
| NPI Number: | 1972598423 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | A032311 |
| Business Practice Address: | 1281 S Patrick Dr 45th Medical Group Patrick Afb, FL - 329253604 |
| Business Phone Number: | 3214946412 |
| Business Fax Number: | 3214941378 |
| Mailing Address: | 1790 Porpoise St, MERRITT ISLAND |
| State: | FL |
| Postal Code: | 329525640 |
| Phone Number: | 3214592594 |
| Fax Number: | |
| NPI Enumeration Date: | 09/12/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | A032311 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |