Provider Demographics
NPI:1558561126
Name:RAJA, GRACE LEE (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:LEE
Last Name:RAJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:LAUREN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 55050
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72215-5050
Mailing Address - Country:US
Mailing Address - Phone:501-906-3000
Mailing Address - Fax:501-907-8367
Practice Address - Street 1:8901 CARTI WAY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6523
Practice Address - Country:US
Practice Address - Phone:501-906-3000
Practice Address - Fax:501-907-8367
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-9857207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology