Provider Demographics
NPI:1093179087
Name:HATEM, RAJA (MD, FRCPC)
Entity Type:Individual
Prefix:DR
First Name:RAJA
Middle Name:
Last Name:HATEM
Suffix:
Gender:M
Credentials:MD, FRCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 FORT WASHINGTON AVENUE ROOM 6-663 (KATHERINE MALAVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-305-2500
Mailing Address - Fax:
Practice Address - Street 1:161 FORT WASHINGTON AVENUE ROOM 6-663 (KATHERINE MALAVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-12-16
Deactivation Date:2016-11-10
Deactivation Code:
Reactivation Date:2016-12-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program