Provider Demographics
NPI:1740517549
Name:MAHARAJ, ELAINE S
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:S
Last Name:MAHARAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-1226
Mailing Address - Country:US
Mailing Address - Phone:423-778-9400
Mailing Address - Fax:423-778-9401
Practice Address - Street 1:855 VINE ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2359
Practice Address - Country:US
Practice Address - Phone:423-778-9400
Practice Address - Fax:423-778-9401
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1370133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered