Provider Demographics
NPI:1053417774
Name:MAHAJAN, RAJENDRA P (MD)
Entity type:Individual
Prefix:
First Name:RAJENDRA
Middle Name:P
Last Name:MAHAJAN
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 1:2060 E PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1448
Mailing Address - Country:US
Mailing Address - Phone:270-684-5034
Mailing Address - Fax:
Practice Address - Street 1:2060 E PARRISH AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1448
Practice Address - Country:US
Practice Address - Phone:270-684-5034
Practice Address - Fax:270-685-1873
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429594207Q00000X
KY41334207Q00000X
IN28153037A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA014582OtherHIGHMARK - GROUP
KY50035630OtherPASSPORT MEDICAID
KY000000736440OtherANTHEM BCBS
KY627606OtherWELLCARE
KY93364OtherCOVENTRYCARES
KYP00471690OtherRR MEDICARE
KY000000527309OtherBCBS
KY7100038730Medicaid
KY50035630OtherPASSPORT MEDICAID
KYI72027Medicare UPIN
PA391860Medicare ID - Type UnspecifiedFQHC
KY0992318Medicare PIN
PA014582Medicare ID - Type UnspecifiedHGSA - GROUP
KY00831001Medicare PIN