Provider Demographics
NPI:1932369709
Name:RAJA, MANSOOR A (MD)
Entity Type:Individual
Prefix:DR
First Name:MANSOOR
Middle Name:A
Last Name:RAJA
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 1:125 DIANA DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:26288-9078
Mailing Address - Country:US
Mailing Address - Phone:304-847-5682
Mailing Address - Fax:
Practice Address - Street 1:125 DIANA DR
Practice Address - Street 2:
Practice Address - City:WEBSTER SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:26288-9078
Practice Address - Country:US
Practice Address - Phone:304-847-5682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-14
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD444076207P00000X
WV25959207P00000X
MI4301093067207P00000X
OH35.123474207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine