Provider Demographics
NPI:1760626436
Name:RAJAGOPALAN, VISWANATHAN (MBBS)
Entity Type:Individual
Prefix:DR
First Name:VISWANATHAN
Middle Name:
Last Name:RAJAGOPALAN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14290 KNOLSON ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4759
Mailing Address - Country:US
Mailing Address - Phone:914-563-2729
Mailing Address - Fax:
Practice Address - Street 1:14290 KNOLSON ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-4759
Practice Address - Country:US
Practice Address - Phone:914-563-2729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2017-08362086S0127X, 208600000X, 2086S0102X
NY254620-1208600000X
NY2546202086S0102X, 2086S0127X
PAMD4178032086S0102X, 2086S0127X, 208G00000X, 208600000X
NY003115208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)