Provider Demographics
NPI:1871747097
Name:JEGANATHAN, RAJKUMAR (MD)
Entity type:Individual
Prefix:
First Name:RAJKUMAR
Middle Name:
Last Name:JEGANATHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GRAND ST
Mailing Address - Street 2:FL 3
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:716-372-0141
Mailing Address - Fax:716-376-2349
Practice Address - Street 1:535 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1500
Practice Address - Country:US
Practice Address - Phone:716-372-0141
Practice Address - Fax:716-376-2349
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276238208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery