Provider Demographics
NPI:1750377925
Name:RAJANAYAGAM, RASA (MD)
Entity type:Individual
Prefix:DR
First Name:RASA
Middle Name:
Last Name:RAJANAYAGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 E LONGBOAT BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4203
Mailing Address - Country:US
Mailing Address - Phone:813-855-1494
Mailing Address - Fax:813-855-1494
Practice Address - Street 1:5715 E LONGBOAT BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4203
Practice Address - Country:US
Practice Address - Phone:813-855-1494
Practice Address - Fax:813-855-1494
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME607102085R0202X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250548700Medicaid