Provider Demographics
NPI:1689762601
Name:RAJU, RAMANATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMANATHAN
Middle Name:
Last Name:RAJU
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 1:25 WINDY HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1131
Mailing Address - Country:US
Mailing Address - Phone:718-668-0012
Mailing Address - Fax:
Practice Address - Street 1:25 WINDY HOLLOW WAY
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1131
Practice Address - Country:US
Practice Address - Phone:718-668-0012
Practice Address - Fax:212-788-0040
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156241208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery