Provider Demographics
NPI:1447631684
Name:RAJ, VIVEK (DO)
Entity type:Individual
Prefix:
First Name:VIVEK
Middle Name:
Last Name:RAJ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7156 TRANQUILITY RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-2098
Mailing Address - Country:US
Mailing Address - Phone:919-597-1118
Mailing Address - Fax:
Practice Address - Street 1:17351 MELFORD BLVD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4457
Practice Address - Country:US
Practice Address - Phone:240-548-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-13
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013937208100000X
WAOP61113387208100000X
MDH97600208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty