Provider Demographics
NPI:1417680547
Name:RAJENDRA P KOIRALA, M.D., LLC
Entity Type:Organization
Organization Name:RAJENDRA P KOIRALA, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:KOIRALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-651-6165
Mailing Address - Street 1:725 BOARDMAN CANFIELD RD STE L1
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4370
Mailing Address - Country:US
Mailing Address - Phone:330-330-8655
Mailing Address - Fax:330-330-8657
Practice Address - Street 1:725 BOARDMAN CANFIELD RD STE L1
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4370
Practice Address - Country:US
Practice Address - Phone:330-330-8655
Practice Address - Fax:330-330-8657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty