1780989863 NPI number — DR. MAHADEVAN RAJARAM MBBS, FACC

Table of content: DR. MAHADEVAN RAJARAM MBBS, FACC (NPI 1780989863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780989863 NPI number — DR. MAHADEVAN RAJARAM MBBS, FACC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAJARAM
Provider First Name:
MAHADEVAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MBBS, FACC
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:
1780989863
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1285 SANDY LANE
Provider Second Line Business Mailing Address:
APT.109
Provider Business Mailing Address City Name:
SARNIA
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
N7V4J7
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1285 SANDY LANE
Provider Second Line Business Practice Location Address:
APT.109
Provider Business Practice Location Address City Name:
SARNIA
Provider Business Practice Location Address State Name:
ONTARIO
Provider Business Practice Location Address Postal Code:
N7V4J7
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
289-887-4801
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/20/2011

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: 207R00000X , with the licence number:  D71366 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: D71366 , 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)





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