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General NPI Number Information
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NPI Number | 1316381833
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Entity Type | Individual
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Provider Name | MANOJ RAJAGOPAL M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2013
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 7697 HEATHERWOOD LN
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City | DUBLIN
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State | OH
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Zip | 43017-8225
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Country | US
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Telephone | 319-364-0121
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Fax |
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Provider Business Mailing Address
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Address Line | 1948 1ST AVE NE
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City | CEDAR RAPIDS
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State | IA
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Zip | 52402-5321
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Country | US
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Telephone | 319-364-0121
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD-53648
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35.135419
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License Number State | OH
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