Healthcare Provider Details

I. General information

NPI: 1013993906
Provider Name (Legal Business Name): RAJDEN KUTELIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR FL 5
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

600 GRESHAM DR FL 5
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-3198
  • Fax: 757-388-4242
Mailing address:
  • Phone: 757-388-3198
  • Fax: 757-388-4242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43232
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101253361
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101253361
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: