Provider Demographics
NPI:1922037449
Name:RAJAN, KRISHNASWAMY SARANGA (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNASWAMY
Middle Name:SARANGA
Last Name:RAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:K S
Other - Middle Name:
Other - Last Name:RAJAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2741 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-7818
Mailing Address - Country:US
Mailing Address - Phone:707-399-8019
Mailing Address - Fax:
Practice Address - Street 1:2741 SEMINOLE DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-7818
Practice Address - Country:US
Practice Address - Phone:707-399-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52095207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD36821OtherMARYLAND LICENSE
MDB44549Medicare UPIN
MD7408KSMedicare ID - Type Unspecified