Provider Demographics
NPI:1790701811
Name:RAJAKUMAR, THEVARAJANI (MD)
Entity Type:Individual
Prefix:
First Name:THEVARAJANI
Middle Name:
Last Name:RAJAKUMAR
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 1:664 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-4818
Mailing Address - Country:US
Mailing Address - Phone:757-393-6363
Mailing Address - Fax:757-393-1336
Practice Address - Street 1:664 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-4818
Practice Address - Country:US
Practice Address - Phone:757-393-6363
Practice Address - Fax:757-393-1336
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240271208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904574Medicaid
NC5904574Medicaid