Provider Demographics
NPI:1801968268
Name:KAMALAM, DHEERAJ RAJENDRANNAIR (MD)
Entity type:Individual
Prefix:DR
First Name:DHEERAJ
Middle Name:RAJENDRANNAIR
Last Name:KAMALAM
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 1:6 LODGE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3912
Mailing Address - Country:US
Mailing Address - Phone:516-348-5344
Mailing Address - Fax:516-482-3512
Practice Address - Street 1:6 LODGE RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3912
Practice Address - Country:US
Practice Address - Phone:516-348-5344
Practice Address - Fax:516-482-3512
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM001403207L00000X, 207LC0200X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H76831Medicare UPIN
HI55033Medicare ID - Type Unspecified