Provider Demographics
NPI:1548605140
Name:RAJAGOPAL, HARI GANESH (MBBS)
Entity Type:Individual
Prefix:DR
First Name:HARI
Middle Name:GANESH
Last Name:RAJAGOPAL
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 MARCUS AVE STE M15
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1034
Mailing Address - Country:US
Mailing Address - Phone:516-601-7200
Mailing Address - Fax:516-601-7380
Practice Address - Street 1:1111 MARCUS AVE STE M15
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1034
Practice Address - Country:US
Practice Address - Phone:516-601-7200
Practice Address - Fax:516-601-7380
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072510A208000000X
NY2836842080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatrics