Provider Demographics
NPI:1770597569
Name:RAJARAM, PERUMALSWAMY (MD)
Entity type:Individual
Prefix:
First Name:PERUMALSWAMY
Middle Name:
Last Name:RAJARAM
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 1:321 E ROBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5253
Mailing Address - Country:US
Mailing Address - Phone:813-685-2191
Mailing Address - Fax:813-689-8755
Practice Address - Street 1:40124 HIGHWAY 27 STE 104
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-5905
Practice Address - Country:US
Practice Address - Phone:863-421-7626
Practice Address - Fax:863-419-2421
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40960208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD53489Medicare UPIN