Provider Demographics
NPI:1679530646
Name:RAJASEKARAN, PALANISAMY (MD)
Entity Type:Individual
Prefix:
First Name:PALANISAMY
Middle Name:
Last Name:RAJASEKARAN
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 1:1180 VINTAGE CLUB DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2008
Mailing Address - Country:US
Mailing Address - Phone:770-329-1216
Mailing Address - Fax:770-696-4051
Practice Address - Street 1:700 MEDICAL CENTER BLVD
Practice Address - Street 2:GWINNETT WOMENS PAVILION
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7693
Practice Address - Country:US
Practice Address - Phone:770-921-4492
Practice Address - Fax:770-696-3358
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0522042080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA083668065EMedicaid
GA083668065LMedicaid
GA083668065MMedicaid
GA083668065IMedicaid
GA083668065JMedicaid
GA083668065KMedicaid