Provider Demographics
NPI:1144282518
Name:MULLOTH, RAJAN (MD)
Entity type:Individual
Prefix:DR
First Name:RAJAN
Middle Name:
Last Name:MULLOTH
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 1:1400 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2009
Mailing Address - Country:US
Mailing Address - Phone:570-383-0236
Mailing Address - Fax:570-383-3681
Practice Address - Street 1:1400 MAIN ST
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2009
Practice Address - Country:US
Practice Address - Phone:570-383-0236
Practice Address - Fax:570-383-3681
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057843L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015887090009Medicaid
PA870936YGDBMedicare PIN
PA0015887090009Medicaid