Provider Demographics
NPI:1285647693
Name:JAIN, RAJENDRA KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJENDRA
Middle Name:KUMAR
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2828 1ST AVE
Mailing Address - Street 2:STE 204 RAJENDA K JAIN MD
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702
Mailing Address - Country:US
Mailing Address - Phone:304-525-7716
Mailing Address - Fax:304-525-7717
Practice Address - Street 1:2828 1ST AVE
Practice Address - Street 2:STE 204 RAJENDA K JAIN MD
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702
Practice Address - Country:US
Practice Address - Phone:304-525-7716
Practice Address - Fax:304-525-7717
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WVWV11477208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0039168000Medicaid
WV0130577000Medicaid
OH0380387Medicaid
WV0039168000Medicaid
OH0380387Medicaid