Basic Information
| Provider Information | |||||||||
| NPI: | 1700962503 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAJANNA | ||||||||
| FirstName: | SUMATHI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 SOUTHWOOD DRIVE | ||||||||
| Address2: | FAMILY MEDICINE | ||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035774440 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2300 SOUTHWOOD DRIVE | ||||||||
| Address2: | FAMILY MEDICINE | ||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035774440 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 08/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | EC061122 | ME | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 14474 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3077245 | 05 | NH | MEDICAID |