Provider Demographics
NPI:1962451468
Name:HOLALKERE, RAJAGOPAL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJAGOPAL
Middle Name:
Last Name:HOLALKERE
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 1:9229 QUEENS BLVD
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1056
Mailing Address - Country:US
Mailing Address - Phone:718-793-1093
Mailing Address - Fax:718-732-1472
Practice Address - Street 1:9229 QUEENS BLVD
Practice Address - Street 2:SUITE 1D
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1056
Practice Address - Country:US
Practice Address - Phone:718-793-1093
Practice Address - Fax:718-732-1472
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG35721Medicare UPIN