Basic Information
| Provider Information | |||||||||
| NPI: | 1265434633 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUVARNA | ||||||||
| FirstName: | RAJENDRA | ||||||||
| MiddleName: | KUMAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 N DIVISION ST | ||||||||
| Address2: | MULTICARE AUBURN MEDICAL CENTER | ||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980014939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533332562 | ||||||||
| FaxNumber: | 2533332622 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 N DIVISION ST | ||||||||
| Address2: | MULTICARE AUBURN MEDICAL CENTER | ||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980014939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533332562 | ||||||||
| FaxNumber: | 2533332622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 11/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 9906 | NV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 9906 | NV | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | MD60092350 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 002018474 | 05 | NV | MEDICAID |