Provider Demographics
NPI:1316062235
Name:BAL M RAJAGOPALAN MD INC A MEDICAL CORP
Entity type:Organization
Organization Name:BAL M RAJAGOPALAN MD INC A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAJAGOPALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-247-0466
Mailing Address - Street 1:9663 SANTA MONICA BLVD
Mailing Address - Street 2:PO 1600
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-247-0466
Mailing Address - Fax:310-247-0782
Practice Address - Street 1:8670 WILSHIRE BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2924
Practice Address - Country:US
Practice Address - Phone:310-247-0466
Practice Address - Fax:310-247-0782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19432Medicare PIN