Basic Information
| Provider Information | |||||||||
| NPI: | 1154322089 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAKAM | ||||||||
| FirstName: | RAJENDRAPRASAD | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1850 W ARLINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278345704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524136641 | ||||||||
| FaxNumber: | 2527526600 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 SE CARY PKWY | ||||||||
| Address2: | STE 204 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198540041 | ||||||||
| FaxNumber: | 9198540049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 200300064 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207ZP0101X | 200300064 | NC | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
ID Information
| ID | Type | State | Issuer | Description | 8913455 | 05 | NC | MEDICAID |