Provider Demographics
NPI:1871587220
Name:DEVANATHAN, RAJA G (MD)
Entity type:Individual
Prefix:DR
First Name:RAJA
Middle Name:G
Last Name:DEVANATHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7875 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6665
Mailing Address - Country:US
Mailing Address - Phone:219-942-9658
Mailing Address - Fax:219-947-1996
Practice Address - Street 1:7875 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6665
Practice Address - Country:US
Practice Address - Phone:219-942-9658
Practice Address - Fax:219-947-1996
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040141A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100379600AMedicaid
INE19490Medicare UPIN
IN100379600AMedicaid