Provider Demographics
NPI:1467412858
Name:TOMAR, RAGHURAJ S (MD)
Entity Type:Individual
Prefix:
First Name:RAGHURAJ
Middle Name:S
Last Name:TOMAR
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 1:76 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-4851
Mailing Address - Country:US
Mailing Address - Phone:856-696-9697
Mailing Address - Fax:856-696-9698
Practice Address - Street 1:2815 E CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-8466
Practice Address - Country:US
Practice Address - Phone:856-696-9697
Practice Address - Fax:856-696-9698
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA057756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6189105Medicaid
NJ056245DRJMedicare PIN
NJ6189105Medicaid