Healthcare Provider Details

I. General information

NPI: 1164438768
Provider Name (Legal Business Name): GEORGE RAJAN SIMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GEORGE RAJAN MD

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 CELEBRATION PL FL 2
CELEBRATION FL
34747-4606
US

IV. Provider business mailing address

380 CELEBRATION PL FL 2
CELEBRATION FL
34747-4606
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number30373
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME83970
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number435665
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME83970
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: