Provider Demographics
NPI:1093730442
Name:RAJAN, SHYAMSUNDAR (MD)
Entity Type:Individual
Prefix:
First Name:SHYAMSUNDAR
Middle Name:
Last Name:RAJAN
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 1:17822 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1020
Mailing Address - Country:US
Mailing Address - Phone:301-570-9700
Mailing Address - Fax:301-260-2838
Practice Address - Street 1:9801 GEORGIA AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5276
Practice Address - Country:US
Practice Address - Phone:301-754-1555
Practice Address - Fax:301-754-3830
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD53367207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02242Medicare ID - Type UnspecifiedGROUP ID#
G02242S01Medicare ID - Type UnspecifiedINDIVIDUAL ID#
MD699144100Medicare ID - Type UnspecifiedMEDICARE ID#
G77160Medicare UPIN