Provider Demographics
NPI:1366441743
Name:MEHDI, RAJA S (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJA
Middle Name:S
Last Name:MEHDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAJA
Other - Middle Name:S
Other - Last Name:MEHDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:239-432-8331
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:6827 W TROPICANA AVE
Practice Address - Street 2:110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4918
Practice Address - Country:US
Practice Address - Phone:702-508-9128
Practice Address - Fax:702-302-4125
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12720207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVI12725Medicare UPIN