Provider Demographics
NPI:1477657070
Name:RAJ, ABHINANDAN (MD)
Entity Type:Individual
Prefix:
First Name:ABHINANDAN
Middle Name:
Last Name:RAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ABHINANDANA
Other - Middle Name:
Other - Last Name:ANANTHARAJU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2214 EMERY ST STE 220
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2470
Mailing Address - Country:US
Mailing Address - Phone:940-383-1400
Mailing Address - Fax:940-383-1411
Practice Address - Street 1:2214 EMERY ST STE 220
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2470
Practice Address - Country:US
Practice Address - Phone:940-383-1400
Practice Address - Fax:940-383-1411
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0063528207RG0100X
TXQ5911207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051520574Medicare ID - Type Unspecified
ALI05933Medicare UPIN
AL051520574Medicaid