Mukund C Raja, M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

026028 Issued in GA

Practice address

475 Philip Blvd
Suite 201
Lawrenceville, GA 30046-8737

Phone

(770) 962-0220

Fax

(770) 962-1566

NPI assigned

Aug 27, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409702400000",
    "number": "1871601229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 PHILIP BLVD",
            "address_2": "SUITE 201",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468737",
            "telephone_number": "770-962-0220",
            "fax_number": "770-962-1566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 PHILIP BLVD",
            "address_2": "SUITE 201",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468737",
            "telephone_number": "770-962-0220",
            "fax_number": "770-962-1566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAJA",
        "first_name": "MUKUND",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-27",
        "last_updated": "2014-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "026028",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00302541A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nasim Rahimi, D.M.D
• Sarah Y Rahman
• Phil Raines III, PSYD
• Tomekia Holandia Raines, LMSW
• Elliot G Raizes, MD
• Susmita Rajanala, M.D.
• Palanisamy Rajasekaran, M.D.
• Dinesh Venkoba Raju, MD, PHD
• Raja Ram, MD
• Tarun Ramayya, MD

• Otolaryngology Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Otolaryngology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.