Provider Demographics
NPI:1235774472
Name:PREJITH RAJ MD PLLC
Entity type:Organization
Organization Name:PREJITH RAJ MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:PREJITH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJENDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-824-7724
Mailing Address - Street 1:1324 TORRENT DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-0859
Mailing Address - Country:US
Mailing Address - Phone:972-824-7724
Mailing Address - Fax:
Practice Address - Street 1:1324 TORRENT DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-0859
Practice Address - Country:US
Practice Address - Phone:972-824-7724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1255758298OtherINDIVIDUAL NPI