Provider Demographics
NPI:1326695917
Name:RAJAN, BETSY VARGHESE (NP)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:VARGHESE
Last Name:RAJAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 NEW LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-5773
Mailing Address - Country:US
Mailing Address - Phone:518-783-1472
Mailing Address - Fax:518-783-1605
Practice Address - Street 1:585 NEW LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-5773
Practice Address - Country:US
Practice Address - Phone:518-783-1472
Practice Address - Fax:518-783-1605
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344084207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology