Provider Demographics
NPI:1972948701
Name:MACHHAR, RAJ (MD)
Entity type:Individual
Prefix:
First Name:RAJ
Middle Name:
Last Name:MACHHAR
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 1:11200 E DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:STE 107
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-8351
Mailing Address - Country:US
Mailing Address - Phone:813-443-3399
Mailing Address - Fax:813-381-3398
Practice Address - Street 1:11200 E DR MLK JR BLVD, #107
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-3358
Practice Address - Country:US
Practice Address - Phone:813-443-3399
Practice Address - Fax:813-381-3478
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283553207R00000X
FLME139320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine