=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104869957
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAJ KUMAR MAHAJAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2006
-----------------------------------------------------
Last Update Date | 01/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42 MONTCALM ST
-----------------------------------------------------
City | OSWEGO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-343-2590
-----------------------------------------------------
Fax | 315-343-4197
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42 MONTCALM STREET
-----------------------------------------------------
City | OSWEGO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-343-2590
-----------------------------------------------------
Fax | 315-343-4197
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 190331-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 190331-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------