Provider Demographics
NPI:1831130202
Name:RAHULA, RAJA (MD)
Entity Type:Individual
Prefix:
First Name:RAJA
Middle Name:
Last Name:RAHULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1112
Mailing Address - Country:US
Mailing Address - Phone:201-963-2200
Mailing Address - Fax:201-963-0011
Practice Address - Street 1:201 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1112
Practice Address - Country:US
Practice Address - Phone:201-963-2200
Practice Address - Fax:201-963-0011
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02897500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3418502Medicaid
NJE70676Medicare UPIN
NJRA440928Medicare ID - Type Unspecified