Provider Demographics
NPI:1659707966
Name:PALANISAMY, RAJARAJESWARAN
Entity Type:Individual
Prefix:
First Name:RAJARAJESWARAN
Middle Name:
Last Name:PALANISAMY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-9472
Mailing Address - Country:US
Mailing Address - Phone:704-718-4676
Mailing Address - Fax:
Practice Address - Street 1:21585 PEABODY ST
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2955
Practice Address - Country:US
Practice Address - Phone:301-475-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14310225100000X
MD24540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist