Healthcare Provider Details

I. General information

NPI: 1770644064
Provider Name (Legal Business Name): RAJALLA E PREWITT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 E 22ND ST STE 200
CLEVELAND OH
44115-3100
US

IV. Provider business mailing address

PO BOX 932127
CLEVELAND OH
44193-0008
US

V. Phone/Fax

Practice location:
  • Phone: 216-363-2570
  • Fax: 216-363-7065
Mailing address:
  • Phone: 216-363-2570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101257433
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD419785
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35-076939
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: