Provider Demographics
NPI:1053392969
Name:BELLAM, RAJENDRA P (MD)
Entity type:Individual
Prefix:DR
First Name:RAJENDRA
Middle Name:P
Last Name:BELLAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20021 SW 111TH PLACE
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-5890
Mailing Address - Country:US
Mailing Address - Phone:352-465-1199
Mailing Address - Fax:352-465-1207
Practice Address - Street 1:20021 SW 111TH PLACE
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-5890
Practice Address - Country:US
Practice Address - Phone:352-465-1199
Practice Address - Fax:352-465-1207
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060472207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110203292OtherRAILROAD MEDICARE PIN
FL989759OtherUNITED HEALTH CARE
FL15174OtherBCBS
FL370922100Medicaid
FLCG8031OtherRAILROAD MEDICARE GROUP
FLC35153Medicare UPIN
FL15174XMedicare PIN
FL110203292OtherRAILROAD MEDICARE PIN
FL15174Medicare ID - Type Unspecified