Provider Demographics
NPI:1346364320
Name:RAJARAM, KITNAMMA (MD)
Entity Type:Individual
Prefix:DR
First Name:KITNAMMA
Middle Name:
Last Name:RAJARAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0066
Mailing Address - Country:US
Mailing Address - Phone:212-848-6456
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROOSEVELT ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10044-0052
Practice Address - Country:US
Practice Address - Phone:212-318-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216529207R00000X
NY0434701207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY21652901OtherNYS LICENSE
NYBR6631952OtherNYS DEA NUMBER