Provider Demographics
NPI:1093970071
Name:PILLAI, RAJEEV KOIPURATH (MD)
Entity Type:Individual
Prefix:
First Name:RAJEEV
Middle Name:KOIPURATH
Last Name:PILLAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAJEEV
Other - Middle Name:K
Other - Last Name:GOPINATHAPILLAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 11314
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4004
Mailing Address - Country:US
Mailing Address - Phone:757-842-4481
Mailing Address - Fax:757-312-3135
Practice Address - Street 1:111 MEDICAL PKWY FL 2
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0302
Practice Address - Country:US
Practice Address - Phone:757-312-4047
Practice Address - Fax:757-410-0339
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-19
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246668207RC0000X, 207RI0011X
NC2008-01212207RC0000X
PAMD458453207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103238112Medicaid
VAGC1100Medicare PIN
PA535176Medicare PIN