Provider Demographics
NPI:1275087728
Name:RAJA, AHMAD (MBBS)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:RAJA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 RIDGE AVE
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3328
Mailing Address - Country:US
Mailing Address - Phone:847-316-4000
Mailing Address - Fax:
Practice Address - Street 1:1 ATWELL RD DEPT OF
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1301
Practice Address - Country:US
Practice Address - Phone:607-547-4586
Practice Address - Fax:607-547-4731
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299578207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine