Provider Demographics
NPI:1073614335
Name:RAJAN, SATHYA P (MD)
Entity Type:Individual
Prefix:
First Name:SATHYA
Middle Name:P
Last Name:RAJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W UNION ST
Mailing Address - Street 2:ATHENS VA OUT PATIENT CLINIC
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2331
Mailing Address - Country:US
Mailing Address - Phone:740-593-7314
Mailing Address - Fax:740-594-2804
Practice Address - Street 1:510 W UNION ST
Practice Address - Street 2:ATHENS VA OUT PATIENT CLINIC
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2331
Practice Address - Country:US
Practice Address - Phone:740-593-7314
Practice Address - Fax:740-594-2804
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350905772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME4322347699Medicaid