Ie, Susanti Rahaju

Ie, Susanti Rahaju is an individual health care provider with primary practice located at 2001 Crystal Spring Ave Sw Suite 300, Roanoke VA 24014-2462. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Critical Care Medicine, Allopathic & Osteopathic Physicians / Pulmonary Disease. Allopathic & Osteopathic Physicians / Pulmonary Disease is her primary health care specialty. Ie, Susanti Rahaju can be contacted via phone (540) 985-8505.

Contact Information

Primary practice address
2001 Crystal Spring Ave Sw Suite 300 Roanoke VA 24014-2462
Phone: (540) 985-8505
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Critical Care Medicine 207RC0200X 050640 Georgia
Allopathic & Osteopathic Physicians / Pulmonary Disease 207RP1001X 050640 Georgia
Allopathic & Osteopathic Physicians / Pulmonary Disease 207RP1001X 0101244044 Virginia

Profile Details

NPI number 1215910781
LBN Legal business name Ie, Susanti Rahaju
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 29th, 2005
Last updated Apr 4th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215910781 NPPES
Georgia MEDICAID 00927616A
Georgia Other 5791203
Georgia Other 874218
Georgia Other 4800175
Georgia Other 290014160
Georgia Other 0932200001
Georgia Other 1944925001
Georgia Other 7024155

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