Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 008474 | AZ |
N | 208000000X | Pediatrician | R2790 | AZ |
NPI | 1003341876 |
---|---|
Provider Name | Dr. Amit Rajaram |
First Address | Phoenix, AZ 85016-7710 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2017 |
Last Update Date | 11/06/2020 |