Provider Demographics
NPI:1154505295
Name:RAJA ATAYA M.D.
Entity Type:Organization
Organization Name:RAJA ATAYA M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ATAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-832-1225
Mailing Address - Street 1:3070 COLLEGE ST # 302
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4691
Mailing Address - Country:US
Mailing Address - Phone:409-832-1225
Mailing Address - Fax:409-832-0927
Practice Address - Street 1:3070 COLLEGE ST # 302
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4691
Practice Address - Country:US
Practice Address - Phone:409-832-1225
Practice Address - Fax:409-832-0927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7157208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty