Provider Demographics
NPI:1750462123
Name:NAVARATNAM, RAJU NEVILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJU
Middle Name:NEVILLE
Last Name:NAVARATNAM
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 1:19 ALGONQUIN AVE
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-5527
Mailing Address - Country:US
Mailing Address - Phone:978-475-4197
Mailing Address - Fax:978-682-8343
Practice Address - Street 1:100 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1132
Practice Address - Country:US
Practice Address - Phone:978-682-8343
Practice Address - Fax:978-682-8343
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74287261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9768041Medicaid