Provider Demographics
NPI:1063496941
Name:RAJ, JAMES LIONEL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LIONEL
Last Name:RAJ
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 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:295 WHARTON LN NE
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1541
Practice Address - Country:US
Practice Address - Phone:276-679-0321
Practice Address - Fax:276-679-6498
Is Sole Proprietor?:No
Enumeration Date:2005-12-03
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.048273207Y00000X
VA0101245034207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4581136OtherAETNA
OH0508329Medicaid
OH1000118OtherUNITED HEALTH CARE
OH000000119340OtherANTHEM
OH000000119340OtherANTHEM
VA019095W82Medicare PIN
OH0508329Medicaid
OH0526084Medicare PIN
VAP00733880Medicare PIN