Healthcare Provider Details

I. General information

NPI: 1316381833
Provider Name (Legal Business Name): MANOJ RAJAGOPAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3403
US

IV. Provider business mailing address

PO BOX 932163
CLEVELAND OH
44193-0008
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-2160
  • Fax: 859-341-4845
Mailing address:
  • Phone: 609-439-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.135419
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD-53648
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: