Provider Demographics
NPI:1881667525
Name:RAJASENAN, KIRAN
Entity type:Individual
Prefix:
First Name:KIRAN
Middle Name:
Last Name:RAJASENAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9930 GRUBBS RD
Mailing Address - Street 2:SOUTH PAVILION GROUND FLOOR SUITE G600
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9930 GRUBBS RD
Practice Address - Street 2:SOUTH PAVILION GROUND FLOOR SUITE G600
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9643
Practice Address - Country:US
Practice Address - Phone:412-367-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067756L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH19407Medicare UPIN
PA038986Medicare ID - Type Unspecified