1154322089 NPI number — MR. RAJENDRAPRASAD V MAKAM MD

Table of content: MRS. PAULA GOODSON RN (NPI 1982396883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154322089 NPI number — MR. RAJENDRAPRASAD V MAKAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAKAM
Provider First Name:
RAJENDRAPRASAD
Provider Middle Name:
V
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154322089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1850 W ARLINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27834-5704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-413-6641
Provider Business Mailing Address Fax Number:
252-752-6600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 SE CARY PKWY
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-854-0041
Provider Business Practice Location Address Fax Number:
919-854-0049
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  200300064 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZP0101X , with the licence number: 200300064 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8913455 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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