Provider Demographics
NPI:1326782525
Name:RAJAGOPALAN, ADITHI
Entity Type:Individual
Prefix:
First Name:ADITHI
Middle Name:
Last Name:RAJAGOPALAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 CRICKLEWOOD DR APT 237
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1817
Mailing Address - Country:US
Mailing Address - Phone:267-316-8561
Mailing Address - Fax:
Practice Address - Street 1:632 N MILL ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1422
Practice Address - Country:US
Practice Address - Phone:810-488-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program