Provider Demographics
NPI:1710210232
Name:RAJA, FURQAN ABBAS (PA)
Entity Type:Individual
Prefix:
First Name:FURQAN
Middle Name:ABBAS
Last Name:RAJA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 DOUGLAS ST STE 500
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-6616
Mailing Address - Country:US
Mailing Address - Phone:919-908-9730
Mailing Address - Fax:919-797-1252
Practice Address - Street 1:1100 4TH ST
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-2415
Practice Address - Country:US
Practice Address - Phone:661-459-1900
Practice Address - Fax:661-459-1974
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04374363A00000X
CAPA20489363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant