Provider Demographics
NPI:1922116219
Name:DR. M. RAJA AND ASSOCIATES, INC
Entity Type:Organization
Organization Name:DR. M. RAJA AND ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUKUND
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-962-0220
Mailing Address - Street 1:475 PHILIP BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-8732
Mailing Address - Country:US
Mailing Address - Phone:770-962-0220
Mailing Address - Fax:770-962-1566
Practice Address - Street 1:475 PHILIP BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-8732
Practice Address - Country:US
Practice Address - Phone:770-962-0220
Practice Address - Fax:770-962-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207VG0400X, 207Y00000X
GAAUD003681237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID