Provider Demographics
NPI:1205819299
Name:RAJAGOPAL, JAYARAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYARAJ
Middle Name:
Last Name:RAJAGOPAL
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:COX 2 PULMONARY AND CRITICAL CARE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-1721
Practice Address - Fax:617-724-9948
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2012-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA159185207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3191150Medicaid
MAJ19849OtherBCBS MA
MA738147OtherTUFTS HEALTH PLAN
MAJ19849OtherBCBS MA
MA3191150Medicaid