Provider Demographics
NPI:1124790324
Name:BIBY RAJAN-GEORGE M.D PLLC
Entity type:Organization
Organization Name:BIBY RAJAN-GEORGE M.D PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BIBY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:RAJAN-GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-637-2665
Mailing Address - Street 1:4000 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE # 403
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066
Mailing Address - Country:US
Mailing Address - Phone:315-637-2665
Mailing Address - Fax:
Practice Address - Street 1:4000 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066
Practice Address - Country:US
Practice Address - Phone:315-637-2665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty