Provider Demographics
NPI:1770644064
Name:PREWITT, RAJALLA E (MD)
Entity Type:Individual
Prefix:
First Name:RAJALLA
Middle Name:E
Last Name:PREWITT
Suffix:
Gender:F
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:PO BOX 932127
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0008
Mailing Address - Country:US
Mailing Address - Phone:216-363-2570
Mailing Address - Fax:
Practice Address - Street 1:2322 E 22ND ST STE 200
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3100
Practice Address - Country:US
Practice Address - Phone:216-363-2570
Practice Address - Fax:216-363-7065
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012574332084P0800X
PAMD4197852084P0804X
OH35-0769392084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019052430001Medicaid
PAH67405Medicare UPIN
PA0019052430001Medicaid