Provider Demographics
NPI:1053520577
Name:RAJAN, DIVYA S (MD)
Entity type:Individual
Prefix:
First Name:DIVYA
Middle Name:S
Last Name:RAJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIVYA
Other - Middle Name:SURESH
Other - Last Name:RAJAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1832 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3366
Mailing Address - Country:US
Mailing Address - Phone:681-207-7130
Mailing Address - Fax:681-207-7132
Practice Address - Street 1:1832 HARPER RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3366
Practice Address - Country:US
Practice Address - Phone:681-207-7129
Practice Address - Fax:681-207-7132
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24136207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810018948Medicaid
WVWV6144E821Medicare PIN
WV3810018948Medicaid