Provider Demographics
NPI:1689651143
Name:RAJKUMAR, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:RAJKUMAR
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 1:112 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2737
Mailing Address - Country:US
Mailing Address - Phone:860-886-8545
Mailing Address - Fax:855-629-7856
Practice Address - Street 1:112 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2737
Practice Address - Country:US
Practice Address - Phone:860-886-8545
Practice Address - Fax:855-629-7856
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038660207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3699514OtherAETNA
CT010038660CT02OtherANTHEM
CT3V0765OtherHEALTHNET
CT001386607Medicaid
CTP3546045OtherOXFORD
CT010038660CT01OtherBC BS
CT9621008OtherCIGNA
CT010038660CT02OtherANTHEM
CT3699514OtherAETNA