Provider Demographics
NPI:1962600809
Name:SAM E RAJIAH M D INC
Entity type:Organization
Organization Name:SAM E RAJIAH M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAJIAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-923-7300
Mailing Address - Street 1:3918 CLOCK POINTE TRL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2989
Mailing Address - Country:US
Mailing Address - Phone:330-923-7300
Mailing Address - Fax:330-923-7301
Practice Address - Street 1:3918 CLOCK POINTE TRL
Practice Address - Street 2:SUITE 102
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2989
Practice Address - Country:US
Practice Address - Phone:330-923-7300
Practice Address - Fax:330-923-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0357242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000128813OtherANTHEM
OH043322000OtherMAGELLAN BEHAVIORAL HEALT
OH280118OtherVALUEOPTIONS
OH4097994OtherAETNA
OH2945609090001OtherMEDICAL MUTUAL INS.
OH0226188Medicaid
OH0226188Medicaid
OHRA0407642Medicare ID - Type Unspecified
OH000000128813OtherANTHEM