Provider Demographics
NPI:1780989863
Name:RAJARAM, MAHADEVAN (MBBS, FACC)
Entity type:Individual
Prefix:DR
First Name:MAHADEVAN
Middle Name:
Last Name:RAJARAM
Suffix:
Gender:M
Credentials:MBBS, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 SANDY LANE
Mailing Address - Street 2:APT.109
Mailing Address - City:SARNIA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N7V4J7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1285 SANDY LANE
Practice Address - Street 2:APT.109
Practice Address - City:SARNIA
Practice Address - State:ONTARIO
Practice Address - Zip Code:N7V4J7
Practice Address - Country:CA
Practice Address - Phone:289-887-4801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD71366207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine