Provider Demographics
NPI:1881833358
Name:RAJARAM, ASWINI (MD)
Entity Type:Individual
Prefix:
First Name:ASWINI
Middle Name:
Last Name:RAJARAM
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 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-762-2468
Mailing Address - Fax:607-762-3871
Practice Address - Street 1:34 MITCHELL AVENUE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903
Practice Address - Country:US
Practice Address - Phone:607-762-2468
Practice Address - Fax:607-762-3871
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003336208000000X
NY267533208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03121482Medicaid
NYJ400004881Medicare PIN