Provider Demographics
NPI:1508851510
Name:DAVE, RAJ C (MD)
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:C
Last Name:DAVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4901 RALEIGH COMMON DR
Mailing Address - Street 2:STE 100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2478
Mailing Address - Country:US
Mailing Address - Phone:901-371-9040
Mailing Address - Fax:901-371-9258
Practice Address - Street 1:4901 RALEIGH COMMON DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128
Practice Address - Country:US
Practice Address - Phone:901-371-9040
Practice Address - Fax:901-371-9258
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2014-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN24507207RI0011X
MS15928207RI0011X
ARE0811207RI0011X
TNMD24507207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3076105Medicaid
4018806OtherBCBS
F64300Medicare UPIN
TN3076105Medicaid
TN3076101Medicare PIN