Provider Demographics
NPI:1831297654
Name:RAJAN, DORAI T (MD)
Entity Type:Individual
Prefix:
First Name:DORAI
Middle Name:T
Last Name:RAJAN
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:807 FARSON ST STE 115
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1068
Practice Address - Country:US
Practice Address - Phone:740-423-3201
Practice Address - Fax:740-423-3211
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10114207R00000X
OH35036925207RH0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01021318OtherRRMCR
OH0547993Medicaid
WV0084188000Medicaid
WVWV1288AMedicare PIN
OH0547993Medicaid
OHP01021318OtherRRMCR
WV0084188000Medicaid