Provider Demographics
NPI:1104869957
Name:MAHAJAN, RAJ KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:RAJ
Middle Name:KUMAR
Last Name:MAHAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 MONTCALM STREET
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126
Mailing Address - Country:US
Mailing Address - Phone:315-343-2590
Mailing Address - Fax:315-343-4197
Practice Address - Street 1:42 MONTCALM ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126
Practice Address - Country:US
Practice Address - Phone:315-343-2590
Practice Address - Fax:315-343-4197
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190331-1174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0160025Medicaid
NYF99997Medicare UPIN
NY0160025Medicaid
NYDD6515Medicare ID - Type Unspecified