Healthcare Provider Details
I. General information
NPI: 1770568834
Provider Name (Legal Business Name): RAJEN P OZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 12/13/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1800 MULBERRY ST.
SCRANTON PA
18510-6800
US
IV. Provider business mailing address
100 N ACADEMY AVE
DANVILLE PA
17822-4903
US
V. Phone/Fax
- Phone: 570-703-8000
- Fax:
- Phone: 570-271-6144
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RH0003X |
| Taxonomy | Hematology & Oncology Physician |
| License Number | MD 056189L |
| License Number State | PA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 002078081 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | HIGHMARK BLUE SHIELD GROUP |
| # 2 | |
| Identifier | 1540287 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 3 | |
| Identifier | 000790785 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | HIGHMARK BC/BS |
| # 4 | |
| Identifier | 50083353 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | CAPITAL BLUE CROSS |
| # 5 | |
| Identifier | 6729703 |
| Identifier Type | MEDICAID |
| Identifier State | NJ |
| Identifier Issuer | |
| # 6 | |
| Identifier | 0071711350002 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 7 | |
| Identifier | 223558181 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | NJ TAX ID # |
| # 8 | |
| Identifier | 524394 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | AETNA |
| # 9 | |
| Identifier | 5732195 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | AETNA GROUP |
| # 10 | |
| Identifier | 10183495590001 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | MEDICAID GROUP |
| # 11 | |
| Identifier | 1518851 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | GATEWAY |
| # 12 | |
| Identifier | 50081639 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | CAPITAL GROUP |
| # 13 | |
| Identifier | 03269300 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | CAPITAL BLUE CROSS |
| # 14 | |
| Identifier | MA 06302800 |
| Identifier Type | OTHER |
| Identifier State | NJ |
| Identifier Issuer | NJ LICENSE # |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
