Provider Demographics
NPI:1508849415
Name:RAJAGOPALAN, LOGI (MD)
Entity Type:Individual
Prefix:DR
First Name:LOGI
Middle Name:
Last Name:RAJAGOPALAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LOGESWARY
Other - Middle Name:
Other - Last Name:RAJAGOPALAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:506 LENOX AVE
Mailing Address - Street 2:MLK17-125
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1802
Mailing Address - Country:US
Mailing Address - Phone:212-939-3702
Mailing Address - Fax:
Practice Address - Street 1:424 E 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4901
Practice Address - Country:US
Practice Address - Phone:212-263-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2513422080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02557817Medicaid
NY02557817Medicaid
NYI02332Medicare UPIN