Provider Demographics
NPI:1942935333
Name:RAJENDRAM, PHAVALAN (MD, FRCPC)
Entity Type:Individual
Prefix:DR
First Name:PHAVALAN
Middle Name:
Last Name:RAJENDRAM
Suffix:
Gender:M
Credentials:MD, FRCPC
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Mailing Address - Street 1:165 CAMBRIDGEPARK DR UNIT 452
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2497
Mailing Address - Country:US
Mailing Address - Phone:781-460-1323
Mailing Address - Fax:
Practice Address - Street 1:330 BROOKLINE AVENUE
Practice Address - Street 2:PALMER 127
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-632-8980
Practice Address - Fax:617-632-8920
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2924052084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology