Provider Demographics
NPI:1306952510
Name:DEWAR, RAJAN (MD, PHD,)
Entity type:Individual
Prefix:DR
First Name:RAJAN
Middle Name:
Last Name:DEWAR
Suffix:
Gender:M
Credentials:MD, PHD,
Other - Prefix:DR
Other - First Name:MUTHUMARTHANDA
Other - Middle Name:RAJAN
Other - Last Name:MARIAPPAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3630 CHARTER PL
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2825
Mailing Address - Country:US
Mailing Address - Phone:617-785-0487
Mailing Address - Fax:
Practice Address - Street 1:3490 CALKINS RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3506
Practice Address - Country:US
Practice Address - Phone:810-733-7741
Practice Address - Fax:855-618-6655
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301108298207ZP0007X, 207ZH0000X, 207ZP0101X, 207ZP0102X
MA229472207ZH0000X, 207ZP0007X
NYNY315695-01207ZH0000X
NYNY-315695-01207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1306952510Medicaid