Provider Demographics
NPI:1043548019
Name:V. RAJA CHANDRA, MD PC
Entity type:Organization
Organization Name:V. RAJA CHANDRA, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATAPERUMAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHANDRASEKARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-324-2294
Mailing Address - Street 1:519 8TH ST
Mailing Address - Street 2:PO BOX 1768
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5460
Mailing Address - Country:US
Mailing Address - Phone:307-324-2294
Mailing Address - Fax:307-328-1964
Practice Address - Street 1:519 8TH ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5460
Practice Address - Country:US
Practice Address - Phone:307-324-2294
Practice Address - Fax:307-328-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2812A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY760011087OtherRAILROAD MEDICARE
WY00072001OtherBCBS
WY106489400Medicaid
WYB42856Medicare UPIN
WYW308288Medicare PIN