Provider Demographics
NPI:1942201165
Name:MADAN, RAJESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:
Last Name:MADAN
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 1:4531 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1102
Mailing Address - Country:US
Mailing Address - Phone:614-527-8787
Mailing Address - Fax:614-527-7287
Practice Address - Street 1:4531 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1102
Practice Address - Country:US
Practice Address - Phone:614-527-8787
Practice Address - Fax:614-527-7287
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH072849207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200107490Medicaid
IN000000108670OtherBLUE SHIELD REID HOSP EKG
OH0254442Medicaid
OH0254442Medicaid
IN200107490Medicaid
IN903830CCMedicare ID - Type UnspecifiedREID HOSPITAL EKG
IN178110Medicare ID - Type Unspecified