1700859394 NPI number — NIRANJANA RAJU MD

Table of content: NIRANJANA RAJU MD (NPI 1700859394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700859394 NPI number — NIRANJANA RAJU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAJU
Provider First Name:
NIRANJANA
Provider Middle Name:
Provider Name Prefix Text:
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:
1700859394
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 366
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STE GENEVIEVE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63670-0366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-883-4477
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STE GENEVIEVE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63670-1539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-883-7474
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2006

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: 207Q00000X , with the licence number:  MOR6A98 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 193294 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 46047 . This is a "HEALTHCARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 999554 . This is a "COMMUNITY CARE PLUS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 060023232 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 201290004 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: A11284 . This is a "MERCY HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0450220 . This is a "UHC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 23094 . This is a "BLUE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 36162 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4574132 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 46047 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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