Provider Demographics
NPI:1891059929
Name:MOURYA, RAJESH (MBBS)
Entity Type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:MOURYA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 COURT AVE
Mailing Address - Street 2:SUITE H314
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163
Mailing Address - Country:US
Mailing Address - Phone:901-448-5737
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-8178
Practice Address - Fax:859-323-8926
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6848207R00000X
KY48013207RI0200X
TNNA207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease