Provider Demographics
NPI:1104885748
Name:MAKKENCHERY, RAJESH (MD)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:MAKKENCHERY
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 1:4 BRIGADIER COURT
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325
Mailing Address - Country:US
Mailing Address - Phone:508-612-8485
Mailing Address - Fax:717-334-1885
Practice Address - Street 1:450 S WASHINGTON ST
Practice Address - Street 2:3RD FLOOR, SUITE C
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2500
Practice Address - Country:US
Practice Address - Phone:717-334-8141
Practice Address - Fax:717-334-1885
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428731208600000X, 2086S0120X, 2086S0127X, 2086X0206X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1840510OtherHIGHMARK BLUE SHIELD
PA20072213OtherAMERIHEALTH MERCY-WMG
PA7842893OtherAETNA
PA211140OtherJOHNS HOPKINS
PA50075821OtherCAPITAL BLUE CROSS WMG
PA101565162Medicaid
PA1551336OtherGATEWAY-WMG
PA232743OtherUNISON WMG
PA1840510OtherHIGHMARK BLUE SHIELD