Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 01055396A | IN |
NPI | 1033150883 |
---|---|
Provider Name | Rajesh Verma |
First Address | Fort Wayne, IN 46805-5100 |
Second Address | Fort Wayne, IN 46805-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 23/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200372280 | (05) | IN |
H55837 | (02) |