Provider Demographics
NPI:1295999605
Name:RAJE, PRADNYA (MD)
Entity type:Individual
Prefix:
First Name:PRADNYA
Middle Name:
Last Name:RAJE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-9603
Mailing Address - Country:US
Mailing Address - Phone:334-497-1922
Mailing Address - Fax:
Practice Address - Street 1:2304 LAKE TRL
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-9603
Practice Address - Country:US
Practice Address - Phone:334-497-1922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44298207Q00000X
IA51950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine