Provider Demographics
NPI:1215143771
Name:RAJA, DEEPAK (MD)
Entity type:Individual
Prefix:
First Name:DEEPAK
Middle Name:
Last Name:RAJA
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 1:6068 S APOPKA VINELAND RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4449
Mailing Address - Country:US
Mailing Address - Phone:407-704-3937
Mailing Address - Fax:407-704-3920
Practice Address - Street 1:6068 S APOPKA VINELAND RD
Practice Address - Street 2:SUITE 10
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4449
Practice Address - Country:US
Practice Address - Phone:407-704-3937
Practice Address - Fax:407-704-3920
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28796207W00000X
FLME106317207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00653579Medicare PIN
AL510I180026Medicare PIN