Provider Demographics
NPI:1588058044
Name:GANESAN, RAJIV JEYAKUMAR (MD)
Entity type:Individual
Prefix:
First Name:RAJIV
Middle Name:JEYAKUMAR
Last Name:GANESAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8355 CHERRY LANE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707
Mailing Address - Country:US
Mailing Address - Phone:301-725-4341
Mailing Address - Fax:301-317-9070
Practice Address - Street 1:8355 CHERRY LANE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707
Practice Address - Country:US
Practice Address - Phone:301-725-4341
Practice Address - Fax:301-317-9070
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0098206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine