Provider Demographics
NPI:1770577108
Name:RAJAN, VK SURESH (MD)
Entity type:Individual
Prefix:DR
First Name:VK SURESH
Middle Name:
Last Name:RAJAN
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 1:13822 BRIARWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6502
Mailing Address - Country:US
Mailing Address - Phone:301-723-4220
Mailing Address - Fax:301-723-4283
Practice Address - Street 1:500 MEMORIAL AVE
Practice Address - Street 2:307 B MEMORIAL MEDICAL BLDG
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3732
Practice Address - Country:US
Practice Address - Phone:301-723-4220
Practice Address - Fax:301-723-4283
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00233122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7025Medicare ID - Type Unspecified
D77807Medicare UPIN