Provider Demographics
NPI:1801005525
Name:JOHNSON, RAJITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJITHA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAJITHA
Other - Middle Name:
Other - Last Name:GOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:801 W PROSPECTOR PL BLDG 1
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-1970
Mailing Address - Country:US
Mailing Address - Phone:402-405-5683
Mailing Address - Fax:
Practice Address - Street 1:NEBRASKA STATE PENITIENTIARY
Practice Address - Street 2:4201 S 14TH ST
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1054
Practice Address - Country:US
Practice Address - Phone:402-479-3218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2023-07-18
Deactivation Date:2021-02-02
Deactivation Code:
Reactivation Date:2021-10-29
Provider Licenses
StateLicense IDTaxonomies
NE17057207R00000X
261QU0200X
IL036-078753207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care