Provider Demographics
NPI:1962843680
Name:RAJENDRAN, AMARABALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMARABALAN
Middle Name:
Last Name:RAJENDRAN
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 1:3 CENTRAL PLZ # 353
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3233
Mailing Address - Country:US
Mailing Address - Phone:516-301-8155
Mailing Address - Fax:
Practice Address - Street 1:3 CENTRAL PLZ # 353
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3233
Practice Address - Country:US
Practice Address - Phone:516-301-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075653207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine