Provider Demographics
NPI:1144273673
Name:RAJAN, SUSHEELA (MD)
Entity type:Individual
Prefix:
First Name:SUSHEELA
Middle Name:
Last Name:RAJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 HOSPITAL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1978
Mailing Address - Country:US
Mailing Address - Phone:513-732-0663
Mailing Address - Fax:513-732-1232
Practice Address - Street 1:2055 HOSPITAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1978
Practice Address - Country:US
Practice Address - Phone:513-732-0663
Practice Address - Fax:513-732-1232
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-077077208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200996490Medicaid
KY7100188370Medicaid
OH2202155Medicaid
OHP00388634OtherRR MEDICARE
OH4027284Medicare PIN
OHP00388634OtherRR MEDICARE
OH4027286Medicare PIN