Provider Demographics
NPI:1326236688
Name:SHYAMSUNDAR RAJAN, MD, PC
Entity Type:Organization
Organization Name:SHYAMSUNDAR RAJAN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SHYAMSUNDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-570-9700
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20861-0157
Mailing Address - Country:US
Mailing Address - Phone:301-570-9700
Mailing Address - Fax:301-260-2838
Practice Address - Street 1:9801 GEORGIA AVE STE 117
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5276
Practice Address - Country:US
Practice Address - Phone:301-754-1555
Practice Address - Fax:301-754-3830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD53367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699144100Medicaid
DE7632OtherRAILROAD MEDICARE
G77160Medicare UPIN
DE7632OtherRAILROAD MEDICARE