Provider Demographics
NPI:1811188055
Name:SARAVANA RAJAN MDPA
Entity Type:Organization
Organization Name:SARAVANA RAJAN MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARAVANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-636-0840
Mailing Address - Street 1:548 BARTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3198
Mailing Address - Country:US
Mailing Address - Phone:321-636-0840
Mailing Address - Fax:321-636-2121
Practice Address - Street 1:548 BARTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3198
Practice Address - Country:US
Practice Address - Phone:321-636-0840
Practice Address - Fax:321-636-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME25452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty