Healthcare Provider Details

I. General information

NPI: 1770520637
Provider Name (Legal Business Name): RAJ LALLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7843 NOTCHED PINE BND
WESLEY CHAPEL FL
33545-5330
US

IV. Provider business mailing address

7843 NOTCHED PINE BND
WESLEY CHAPEL FL
33545-5330
US

V. Phone/Fax

Practice location:
  • Phone: 609-213-2023
  • Fax:
Mailing address:
  • Phone: 609-213-2023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME154369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: