Provider Demographics
NPI:1164678777
Name:MADAN, RAJAT (MD, PHD)
Entity Type:Individual
Prefix:
First Name:RAJAT
Middle Name:
Last Name:MADAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636256
Mailing Address - Street 2:CENTRAL CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5504
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:231 ALBERT SABIN WAY
Practice Address - Street 2:ML 0560
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0560
Practice Address - Country:US
Practice Address - Phone:513-558-4707
Practice Address - Fax:513-558-2089
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.096037207R00000X
OH35-096037207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine