Provider Demographics
NPI:1982441002
Name:CHENNURI, RAJ NANDAN (MBBS)
Entity type:Individual
Prefix:MR
First Name:RAJ
Middle Name:NANDAN
Last Name:CHENNURI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 POCONO ROAD
Mailing Address - Street 2:ST CLARE'S HEALTH, GRADUATE MEDICAL EDUCATION
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834
Mailing Address - Country:US
Mailing Address - Phone:973-365-4661
Mailing Address - Fax:
Practice Address - Street 1:25 POCONO ROAD
Practice Address - Street 2:ST CLARE'S HEALTH, GRADUATE MEDICAL EDUCATION
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834
Practice Address - Country:US
Practice Address - Phone:973-365-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program