Provider Demographics
NPI:1043508070
Name:MAHENDRARAJAH, SULAGSHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SULAGSHAN
Middle Name:
Last Name:MAHENDRARAJAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 WITTENBURGH APT 2408
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-2692
Mailing Address - Country:US
Mailing Address - Phone:319-383-1834
Mailing Address - Fax:
Practice Address - Street 1:520 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4334
Practice Address - Country:US
Practice Address - Phone:541-789-5790
Practice Address - Fax:541-789-5711
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-9294207R00000X
IDM-175492084N0400X
ORMD1703012084N0400X
TXT26722084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine