Provider Demographics
NPI:1770520637
Name:LALLA, RAJ (MD)
Entity type:Individual
Prefix:DR
First Name:RAJ
Middle Name:
Last Name:LALLA
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 1:2051 KLOCKNER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3413
Mailing Address - Country:US
Mailing Address - Phone:609-584-8898
Mailing Address - Fax:
Practice Address - Street 1:2051 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3413
Practice Address - Country:US
Practice Address - Phone:609-584-8898
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ48012208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084545Medicare ID - Type UnspecifiedGROUP ID
NJE13151Medicare UPIN