Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 016448 | ME |
NPI | 1053369744 |
---|---|
Provider Name | Thomas Rajan |
First Address | Bangor, ME 04401-6690 |
Second Address | Bangor, ME 04401-6690 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 25/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
047486 | BLUE CROSS (01) | ME |
409670099 | (05) | ME |
H69667 | (02) | |
P00175730 | RAILROAD MEDICARE (01) | ME |