Provider Demographics
NPI:1982789160
Name:THOTAKURA, RAJAKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:RAJAKUMAR
Middle Name:
Last Name:THOTAKURA
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 ASHLEYBROOK SQUARE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-765-6577
Mailing Address - Fax:336-768-2972
Practice Address - Street 1:125 ASHLEYBROOK SQUARE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-765-6577
Practice Address - Fax:336-768-2972
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93003442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8983345Medicaid
83345OtherBCBS OF NC
NC8983345Medicaid
83345OtherBCBS OF NC