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General NPI Number Information
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NPI Number | 1962453977
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Entity Type | Individual
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Provider Name | MYTHILI RAJAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/14/2006
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 3024 NEW BERN AVE
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City | RALEIGH
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State | NC
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Zip | 27610-1247
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Country | US
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Telephone | 919-350-8009
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Fax | 919-350-8147
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Provider Business Mailing Address
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Address Line | 3024 NEW BERN AVE
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City | RALEIGH
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State | NC
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Zip | 27610-1247
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Country | US
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Telephone | 919-350-8009
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Fax | 919-350-8147
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 23075
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License Number State | NC
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