Basic Information
| Provider Information | |||||||||
| NPI: | 1891882346 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATHMARAJAH | ||||||||
| FirstName: | RAJARATNAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 229 | ||||||||
| Address2: | |||||||||
| City: | MIAMISBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453430229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138740486 | ||||||||
| FaxNumber: | 5132808868 | ||||||||
| Practice Location | |||||||||
| Address1: | 6730 ROOSEVELT AVE STE 303 | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450050017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138740486 | ||||||||
| FaxNumber: | 5132808868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 04/19/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35-087707 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 35-087707 | OH | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RA0000X | 35.087707 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000519937 | 01 | BCBS FAIRFIELD HOS | OTHER | P01013479 | 01 | OH | RR MEDICARE | OTHER | 2700545 | 05 | OH | MEDICAID | 201035790 | 05 | IN | MEDICAID | 317497 | 01 | AMERIGROUP | OTHER | 7100198040 | 05 | KY | MEDICAID |