Provider Demographics
NPI:1417938390
Name:SAMTANI, RAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJ
Middle Name:
Last Name:SAMTANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9131 PISCATAWAY RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2508
Mailing Address - Country:US
Mailing Address - Phone:301-868-3003
Mailing Address - Fax:301-932-8544
Practice Address - Street 1:9131 PISCATAWAY RD
Practice Address - Street 2:SUITE 280
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2508
Practice Address - Country:US
Practice Address - Phone:301-868-3003
Practice Address - Fax:301-932-8544
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0027744207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD47270OtherMAMSI
DC47270OtherOPTIMUM CHOICE
DC5352-0001OtherBC BS NCA
MDB93859Medicare UPIN
DC47270OtherOPTIMUM CHOICE