Provider Demographics
NPI:1508926668
Name:DEVARAJAN, RAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJ
Middle Name:
Last Name:DEVARAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THIAGARAJAN
Other - Middle Name:
Other - Last Name:DEVARAJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:45B DISCOVERY WAY
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4482
Mailing Address - Country:US
Mailing Address - Phone:978-429-2010
Mailing Address - Fax:978-264-1935
Practice Address - Street 1:45B DISCOVERY WAY
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4482
Practice Address - Country:US
Practice Address - Phone:978-429-2010
Practice Address - Fax:978-264-1935
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59830207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9773495Medicaid
MA9773495Medicaid
MAD88514Medicare UPIN