1962600809 NPI number — SAM E RAJIAH M D INC

Table of content: (NPI 1962600809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962600809 NPI number — SAM E RAJIAH M D INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAM E RAJIAH 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:
1962600809
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3918 CLOCK POINTE TRL
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
STOW
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44224-2989
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-923-7300
Provider Business Mailing Address Fax Number:
330-923-7301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3918 CLOCK POINTE TRL
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
STOW
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44224-2989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-923-7300
Provider Business Practice Location Address Fax Number:
330-923-7301
Provider Enumeration Date:
07/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAJIAH
Authorized Official First Name:
SAM
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRES.
Authorized Official Telephone Number:
330-923-7300

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  035724 , 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: 000000128813 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 043322000 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 280118 . This is a "VALUEOPTIONS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4097994 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2945609090001 . This is a "MEDICAL MUTUAL INS." identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0226188 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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