Provider Demographics
NPI:1043332786
Name:RAJ, AMAN (CPO)
Entity Type:Individual
Prefix:
First Name:AMAN
Middle Name:
Last Name:RAJ
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 COX ROAD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0628
Mailing Address - Country:US
Mailing Address - Phone:704-866-7772
Mailing Address - Fax:704-866-4292
Practice Address - Street 1:561 COX ROAD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0628
Practice Address - Country:US
Practice Address - Phone:704-866-7772
Practice Address - Fax:704-866-4292
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795068Medicaid
NC7702806Medicaid
NC7795068Medicaid