Provider Demographics
NPI:1699713354
Name:SIVAPRASAD, RAJAGOPALAN (MD)
Entity type:Individual
Prefix:DR
First Name:RAJAGOPALAN
Middle Name:
Last Name:SIVAPRASAD
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 1:250 WASHINGTON ST
Mailing Address - Street 2:STE C2
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7575
Mailing Address - Country:US
Mailing Address - Phone:732-842-5272
Mailing Address - Fax:732-244-1005
Practice Address - Street 1:300 2ND AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6303
Practice Address - Country:US
Practice Address - Phone:732-842-5272
Practice Address - Fax:732-244-1005
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA44168207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53744Medicare UPIN
NJ179587Medicare ID - Type Unspecified