Provider Demographics
NPI:1427041367
Name:RAJAN, SEMUR PERUMAL (MD)
Entity Type:Individual
Prefix:MR
First Name:SEMUR
Middle Name:PERUMAL
Last Name:RAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:SEMUR
Other - Middle Name:PERUMAL GOUNDER
Other - Last Name:RAJAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:275 CLINE AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1019
Mailing Address - Country:US
Mailing Address - Phone:419-756-1230
Mailing Address - Fax:419-756-8654
Practice Address - Street 1:275 CLINE AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1019
Practice Address - Country:US
Practice Address - Phone:419-756-1230
Practice Address - Fax:419-756-8654
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033496R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000389423OtherANTHEM BLUE CROSS
OH000000181984Medicaid
OH0166252Medicaid
OH204064680026Medicaid
OH733669Medicaid
OH000000389423OtherANTHEM BLUE CROSS
OH9360491Medicare ID - Type Unspecified
OH0166252Medicaid