Provider Demographics
NPI:1932111424
Name:DHARMARAJA, PRITHVIRAJ (MD)
Entity Type:Individual
Prefix:
First Name:PRITHVIRAJ
Middle Name:
Last Name:DHARMARAJA
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 5688
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-5688
Mailing Address - Country:US
Mailing Address - Phone:661-529-7550
Mailing Address - Fax:661-529-7560
Practice Address - Street 1:1331 W AVENUE J STE 202
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-529-7550
Practice Address - Fax:661-529-7560
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43516207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A435160Medicaid
CAE38649Medicare ID - Type Unspecified