Provider Demographics
NPI:1417339789
Name:MYMD4ME LLC
Entity Type:Organization
Organization Name:MYMD4ME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAGHURAJ
Authorized Official - Middle Name:S
Authorized Official - Last Name:TOMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-498-0845
Mailing Address - Street 1:49 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-4818
Mailing Address - Country:US
Mailing Address - Phone:856-696-3463
Mailing Address - Fax:856-691-0440
Practice Address - Street 1:49 S STATE ST
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4818
Practice Address - Country:US
Practice Address - Phone:856-696-3463
Practice Address - Fax:856-691-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2016-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05775600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0493881Medicaid
NJ460187Medicare PIN