Provider Demographics
NPI:1275598633
Name:RAJAN, NATARAJAN (MD)
Entity Type:Individual
Prefix:
First Name:NATARAJAN
Middle Name:
Last Name:RAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870
Mailing Address - Country:US
Mailing Address - Phone:252-308-6889
Mailing Address - Fax:252-308-0049
Practice Address - Street 1:117 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870
Practice Address - Country:US
Practice Address - Phone:252-308-6889
Practice Address - Fax:252-308-0049
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800672208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1141XOtherBCBS
NC891141XMedicaid
NC2253901BMedicare ID - Type Unspecified
NC891141XMedicaid