MEDICARE: RAJESH GOVINDASAMY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	MD418543	PA
2	208M00000X	Hospitalist Physician	MD418543	PA
3	207R00000X	Internal Medicine Physician	MD 418543	PA

General Provider Information

NPI Number	:	1649372319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJESH GOVINDASAMY M.D.

Provider Business Mailing Address
First Line	:	300 STATE ST STE 207
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16507-1429
Country	:	US
Telephone Number	:	814-877-3625
Fax Number	:	814-877-3661

Provider Business Practice Location Address
First Line	:	300 STATE ST STE 207
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16507-1429
Country	:	US
Telephone Number	:	814-877-3696
Fax Number	:	814-877-3661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	02/07/2024

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