Individual
DR. ILAYA RAMANAN RAJAGOPAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
24 N WALNUT ST, HAGERSTOWN, MD 21740-4738
(301) 393-3447
(301) 393-3463
Mailing address
24 N WALNUT ST, HAGERSTOWN, MD 21740-4738
(301) 393-3447
(301) 393-3463
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
LL520
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LL520
LIC REG CERT NO
MD
Enumeration date
03/12/2007
Last updated
07/08/2007
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