Provider Demographics
NPI:1407887680
Name:RAJ, PRASANTA KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASANTA
Middle Name:KUMAR
Last Name:RAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:18099 LORAIN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5610
Mailing Address - Country:US
Mailing Address - Phone:216-671-1140
Mailing Address - Fax:216-671-2889
Practice Address - Street 1:18099 LORAIN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5610
Practice Address - Country:US
Practice Address - Phone:216-671-1140
Practice Address - Fax:216-671-2889
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35041777208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000508239OtherANTHEM
OHP00610099OtherRR IND MEDICARE #
OH0119204OtherGROUP MEDICAID
OH0431465Medicaid
OH1780634279OtherGROUP NPI
OH9273172OtherGROUP MEDICARE
CA4511OtherGROUP RR MEDICARE
OH9273172OtherGROUP MEDICARE
OH0431465Medicaid
OH1780634279OtherGROUP NPI