Healthcare Provider Details

I. General information

NPI: 1245813740
Provider Name (Legal Business Name): RAJAN PRASAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 06/17/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MARKET ST
BOARDMAN OH
44512-6725
US

IV. Provider business mailing address

1350 E MARKET STREET
WARREN OH
44483
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-4298
  • Fax:
Mailing address:
  • Phone: 330-675-5714
  • Fax: 330-675-5721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.150162
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: