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General NPI Number Information
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NPI Number | 1407887680
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Entity Type | Individual
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Provider Name | PRASANTA KUMAR RAJ M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 18099 LORAIN AVE SUITE 200
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City | CLEVELAND
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State | OH
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Zip | 44111-5610
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Country | US
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Telephone | 216-671-1140
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Fax | 216-671-2889
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Provider Business Mailing Address
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Address Line | 18099 LORAIN AVE SUITE 200
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City | CLEVELAND
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State | OH
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Zip | 44111-5610
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Country | US
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Telephone | 216-671-1140
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Fax | 216-671-2889
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35041777
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License Number State | OH
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