Individual
DR. SUSANTI RAHAJU IE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2001 CRYSTAL SPRING AVE SW, SUITE 300, ROANOKE, VA 24014-2462
(540) 985-8505
Mailing address
2001 CRYSTAL SPRING AVE SW, SUITE 300, ROANOKE, VA 24014-2462
(540) 985-8505
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
050640
GA
207RP1001X
Pulmonary Disease Physician
Primary
0101244044
VA
207RP1001X
Pulmonary Disease Physician
050640
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00927616A
—
GA
01
—
0932200001
WORKERS COMPENSATION
GA
01
—
1944925001
CIGNA
—
01
—
290014160
RAILROAD MEDICARE
GA
01
—
4800175
UNITED HEALTHCARE
—
01
—
5791203
GHI
—
01
—
7024155
AETNA
—
01
—
874218
BLUE CROSS BLUE SHIELD
GA
Enumeration date
11/29/2005
Last updated
04/04/2017
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