Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101245034 | VA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 35.048273 | OH |
NPI | 1063496941 |
---|---|
Provider Name | James Lionel Raj |
First Address | Kingsport, TN 37660-4632 |
Second Address | Norton, VA 24273-1541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2005 |
Last Update Date | 27/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000119340 | ANTHEM (01) | OH |
0508329 | (05) | OH |
1000118 | UNITED HEALTH CARE (01) | OH |
4581136 | AETNA (01) | OH |
A15310 | (02) | OH |