1326236688 NPI number — SHYAMSUNDAR RAJAN, MD, PC

Table of content: (NPI 1326236688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326236688 NPI number — SHYAMSUNDAR RAJAN, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHYAMSUNDAR RAJAN, MD, PC
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:
1326236688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20861-0157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-570-9700
Provider Business Mailing Address Fax Number:
301-260-2838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9801 GEORGIA AVE STE 117
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20902-5276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-754-1555
Provider Business Practice Location Address Fax Number:
301-754-3830
Provider Enumeration Date:
10/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAJAN
Authorized Official First Name:
SHYAMSUNDAR
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
301-570-9700

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D53367 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 699144100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE7632 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com