Provider Demographics
NPI:1114971025
Name:RAJAN, RAJ T (MD)
Entity Type:Individual
Prefix:MR
First Name:RAJ
Middle Name:T
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 1:2010 59TH ST W
Mailing Address - Street 2:SUITE #4200
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-4687
Mailing Address - Country:US
Mailing Address - Phone:941-794-3999
Mailing Address - Fax:941-792-4048
Practice Address - Street 1:2010 59TH ST W
Practice Address - Street 2:SUITE #4200
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4687
Practice Address - Country:US
Practice Address - Phone:941-794-3999
Practice Address - Fax:941-792-4048
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059046207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375960100Medicaid
FLF22798Medicare UPIN
FL375960100Medicaid