Individual
DR. PRASANTA KUMAR RAJ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
18099 LORAIN AVE, SUITE 200, CLEVELAND, OH 44111-5610
(216) 671-1140
(216) 671-2889
Mailing address
18099 LORAIN AVE, SUITE 200, CLEVELAND, OH 44111-5610
(216) 671-1140
(216) 671-2889
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
35041777
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000508239
ANTHEM
—
01
—
0119204
GROUP MEDICAID
OH
05
—
0431465
—
OH
01
—
1780634279
GROUP NPI
OH
01
—
9273172
GROUP MEDICARE
OH
01
—
CA4511
GROUP RR MEDICARE
—
01
—
P00610099
RR IND MEDICARE #
OH
Enumeration date
07/05/2006
Last updated
11/29/2012
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