Provider Demographics
NPI:1154322089
Name:MAKAM, RAJENDRAPRASAD V (MD)
Entity Type:Individual
Prefix:MR
First Name:RAJENDRAPRASAD
Middle Name:V
Last Name:MAKAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1850 W ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5704
Mailing Address - Country:US
Mailing Address - Phone:252-413-6641
Mailing Address - Fax:252-752-6600
Practice Address - Street 1:1120 SE CARY PKWY
Practice Address - Street 2:STE 204
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511
Practice Address - Country:US
Practice Address - Phone:919-854-0041
Practice Address - Fax:919-854-0049
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300064207RG0100X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913455Medicaid
NC2332156Medicare ID - Type UnspecifiedGROUP
NC8913455Medicaid
G35000Medicare UPIN