Provider Demographics
NPI:1225350358
Name:SUJATHA RAJAGOPALAN,M.D.,INC
Entity Type:Organization
Organization Name:SUJATHA RAJAGOPALAN,M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUJATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJAGOPALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-361-5531
Mailing Address - Street 1:PO BOX 478
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-0478
Mailing Address - Country:US
Mailing Address - Phone:925-361-5531
Mailing Address - Fax:
Practice Address - Street 1:2301 CAMINO RAMON
Practice Address - Street 2:STE 110
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4440
Practice Address - Country:US
Practice Address - Phone:925-361-5531
Practice Address - Fax:925-361-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87097207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H55247Medicare UPIN
CA00A870970Medicare PIN