Provider Demographics
NPI:1699722280
Name:SAJJAN, RAJENDRA N (MD)
Entity type:Individual
Prefix:
First Name:RAJENDRA
Middle Name:N
Last Name:SAJJAN
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 1:7119 NOTTAWAY DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5883
Mailing Address - Country:US
Mailing Address - Phone:740-645-2833
Mailing Address - Fax:
Practice Address - Street 1:7119 NOTTAWAY DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5883
Practice Address - Country:US
Practice Address - Phone:740-645-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-3487207R00000X
TXP1402208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2500225Medicaid
000000322021OtherANTHEM BCBS
OH000000185269OtherUNISON MEDICAID #
001714151OtherMOUNTAIN STATE BCBS
1699722280OtherNPI
WV2006784000Medicaid
OHP00074055OtherRR MEDICARE
OH4125252Medicare PIN
000000322021OtherANTHEM BCBS