Basic Information
| Provider Information | |||||||||
| NPI: | 1932369709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAJA | ||||||||
| FirstName: | MANSOOR | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 GALAXY WAY STE 400 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945205725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252255837 | ||||||||
| FaxNumber: | 9252255838 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257021241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045261111 | ||||||||
| FaxNumber: | 9252255838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2008 | ||||||||
| LastUpdateDate: | 11/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 4301093067 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 35.123474 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD444076 | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 25959 | WV | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.