1225180672 NPI number — SEMUR P. RAJAN, M.D., INC

Table of content: (NPI 1225180672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225180672 NPI number — SEMUR P. RAJAN, M.D., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEMUR P. RAJAN, M.D., INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1225180672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 CLINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44907-1019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-756-1230
Provider Business Mailing Address Fax Number:
419-756-8654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 CLINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44907-1019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-756-1230
Provider Business Practice Location Address Fax Number:
419-756-8654
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAJAN
Authorized Official First Name:
SEMUR
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
419-756-1230

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  35033496R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 302425177005 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 733669 . This is a "BUCKEYE COMMUNITY HEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0166252 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000389423 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000181984 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30242517700 . This is a "WORKER'S COMP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: DE5301 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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