Provider Demographics
NPI:1528033651
Name:RAJJOUB, RODWAN K (MD)
Entity type:Individual
Prefix:
First Name:RODWAN
Middle Name:K
Last Name:RAJJOUB
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 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:904 CAMPBELL ST
Practice Address - Street 2:SUITE 104
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3154
Practice Address - Country:US
Practice Address - Phone:570-326-2035
Practice Address - Fax:570-326-9220
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038209L174400000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008460030003Medicaid
PA0008460030003Medicaid
PA0008460030003Medicaid