Provider Demographics
NPI:1669462040
Name:RAJ, VIJAY (MD)
Entity Type:Individual
Prefix:MR
First Name:VIJAY
Middle Name:
Last Name:RAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 DOVETAIL FALLS LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-1706
Mailing Address - Country:US
Mailing Address - Phone:571-344-8084
Mailing Address - Fax:
Practice Address - Street 1:2110 DOVETAIL FALLS LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-1706
Practice Address - Country:US
Practice Address - Phone:157-134-4808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035132207QA0505X
FLME 128772208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine