Provider Demographics
NPI:1013991504
Name:RAJE, NOOPUR SURESH (MD)
Entity type:Individual
Prefix:DR
First Name:NOOPUR
Middle Name:SURESH
Last Name:RAJE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS. GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-4000
Mailing Address - Fax:617-726-0453
Practice Address - Street 1:55 FRUIT ST YAW 7
Practice Address - Street 2:HEMATOLOGY/ONCOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA468285OtherTUFTS HEALTH PLAN
MAJ28680OtherBCBS OF MA
MA2102099Medicaid
MAA38588Medicare ID - Type Unspecified
MAJ28680OtherBCBS OF MA