Provider Demographics
NPI:1316062136
Name:RAJ, GEORGE STEPHAN (MD,)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:STEPHAN
Last Name:RAJ
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:STEPHAN
Other - Last Name:RAJ L
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD,
Mailing Address - Street 1:12 BELLWETHER WAY
Mailing Address - Street 2:SUITE 219
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2959
Mailing Address - Country:US
Mailing Address - Phone:360-200-5826
Mailing Address - Fax:
Practice Address - Street 1:12 BELLWETHER WAY
Practice Address - Street 2:SUITE 219
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2959
Practice Address - Country:US
Practice Address - Phone:360-200-5826
Practice Address - Fax:360-200-5833
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040143542081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine