Provider Demographics
NPI:1972555100
Name:BHARATHAN, RAJAPILLAI K (MD PC)
Entity Type:Individual
Prefix:
First Name:RAJAPILLAI
Middle Name:K
Last Name:BHARATHAN
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:424 ELM AVE SW
Mailing Address - Street 2:RAJ K BHARATHAN MD
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-3920
Mailing Address - Country:US
Mailing Address - Phone:540-265-4850
Mailing Address - Fax:540-265-4852
Practice Address - Street 1:424 ELM AVE SW
Practice Address - Street 2:RAJ K BHARATHAN MD
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-3920
Practice Address - Country:US
Practice Address - Phone:540-265-4850
Practice Address - Fax:540-265-4852
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005816645Medicaid
110176196OtherMCRR
324728OtherANTHEM
VA005816645Medicaid
324728OtherANTHEM