Provider Demographics
NPI:1881609196
Name:RAJ P CHOPRA MD PC
Entity type:Organization
Organization Name:RAJ P CHOPRA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHOPRA
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:570-784-3711
Mailing Address - Street 1:326 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1729
Mailing Address - Country:US
Mailing Address - Phone:570-784-3711
Mailing Address - Fax:570-784-3997
Practice Address - Street 1:326 MARKET ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1729
Practice Address - Country:US
Practice Address - Phone:570-784-3711
Practice Address - Fax:570-784-3997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029727L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006789000001Medicaid
PA0006789000001Medicaid
PA017905Medicare PIN
PAC27375Medicare UPIN