Provider Demographics
NPI:1891882346
Name:PATHMARAJAH, RAJARATNAM (MD)
Entity Type:Individual
Prefix:
First Name:RAJARATNAM
Middle Name:
Last Name:PATHMARAJAH
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 229
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45343-0229
Mailing Address - Country:US
Mailing Address - Phone:513-874-0486
Mailing Address - Fax:513-280-8868
Practice Address - Street 1:6730 ROOSEVELT AVE STE 303
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-0017
Practice Address - Country:US
Practice Address - Phone:513-874-0486
Practice Address - Fax:513-280-8868
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-087707207R00000X, 208M00000X
OH35.087707207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000519937OtherBCBS FAIRFIELD HOS
OHP01013479OtherRR MEDICARE
OH2700545Medicaid
IN201035790Medicaid
317497OtherAMERIGROUP
KY7100198040Medicaid
OHH006250Medicare PIN
OHP01013479OtherRR MEDICARE