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NPI Code Detail

MEDICARE: PREETHI RAJAN

MEDICARE: PREETHI RAJAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2208000000XPediatrics Physician92648GA

General Provider Information

NPI Number : 1376106534
Entity Type Code : Individual
Provider Name (Legal Business Name) : PREETHI RAJAN
Provider Business Mailing Address
First Line : 101 RIVERFRONT BLVD STE 710
Second Line :
City : BRADENTON
State : FL
Zip : 34205-8812
Country : US
Telephone Number : 941-776-4000
Fax Number :
Provider Business Practice Location Address
First Line : 4112 E PONCE DE LEON AVE
Second Line :
City : CLARKSTON
State : GA
Zip : 30021-8106
Country : US
Telephone Number : 404-296-7133
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2019
Last Update Date : 10/20/2022

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Directions to “ PREETHI RAJAN ” Practice Location

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