Provider Demographics
NPI:1700962503
Name:RAJANNA, SUMATHI (MD)
Entity type:Individual
Prefix:DR
First Name:SUMATHI
Middle Name:
Last Name:RAJANNA
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 1:2300 SOUTHWOOD DRIVE
Mailing Address - Street 2:FAMILY MEDICINE
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063
Mailing Address - Country:US
Mailing Address - Phone:603-577-4440
Mailing Address - Fax:
Practice Address - Street 1:2300 SOUTHWOOD DRIVE
Practice Address - Street 2:FAMILY MEDICINE
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063
Practice Address - Country:US
Practice Address - Phone:603-577-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEEC061122207Q00000X
NH14474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077245Medicaid