Provider Demographics
NPI:1508840034
Name:RAJ, ASHOK B (MD)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:B
Last Name:RAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-3600
Mailing Address - Fax:502-588-9536
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:STE 601
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3902
Practice Address - Country:US
Practice Address - Phone:502-588-3600
Practice Address - Fax:502-588-9536
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2021-09-03
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Provider Licenses
StateLicense IDTaxonomies
KY36071208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64008774Medicaid
IN200286450Medicaid
IN200286450Medicaid
KYK022631Medicare PIN