Provider Demographics
NPI:1952412306
Name:RAJAPILLAI K BHARATHAN MD PC
Entity Type:Organization
Organization Name:RAJAPILLAI K BHARATHAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJAPILLAI
Authorized Official - Middle Name:K
Authorized Official - Last Name:BHARATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-265-4085
Mailing Address - Street 1:PO BOX 4127
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-0127
Mailing Address - Country:US
Mailing Address - Phone:540-981-9394
Mailing Address - Fax:540-344-7154
Practice Address - Street 1:424 ELM AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-3920
Practice Address - Country:US
Practice Address - Phone:540-265-4850
Practice Address - Fax:540-265-4852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005816645Medicaid
VAF96973Medicare UPIN
VA110007223Medicare PIN