Provider Demographics
NPI:1306861489
Name:SAXENA, RAJ K (MD)
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:K
Last Name:SAXENA
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 1:200 E HIGHLAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2582
Mailing Address - Country:US
Mailing Address - Phone:352-394-3611
Mailing Address - Fax:352-394-0739
Practice Address - Street 1:200 E HIGHLAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2582
Practice Address - Country:US
Practice Address - Phone:352-394-3611
Practice Address - Fax:352-394-0739
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057361207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2037OtherMC EMC
FL373767500Medicaid
FL12107AMedicare PIN
FL12107Medicare PIN
FL12107DMedicare PIN
FLE95690Medicare UPIN
FLK2037OtherMC EMC
FL12107YMedicare PIN
FL12107BMedicare PIN