Provider Demographics
NPI:1225371818
Name:RAJ, MARC ALEXANDER (DO)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ALEXANDER
Last Name:RAJ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:105 MEDICAL CENTER DR STE 103
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461
Practice Address - Country:US
Practice Address - Phone:985-639-3777
Practice Address - Fax:985-646-5839
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO1858208100000X, 208VP0014X
CA20A15518208100000X
MS25859208100000X, 208VP0014X
LA304483208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine