Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | D53367 | MD |
NPI | 1093730442 |
---|---|
Provider Name | Shyamsundar Rajan |
First Address | North Potomac, MD 20878-1020 |
Second Address | Silver Spring, MD 20902-5276 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 17/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G77160 | (02) |