Provider Demographics
NPI:1134342819
Name:RASTOGI, ANJANA (MD)
Entity type:Individual
Prefix:
First Name:ANJANA
Middle Name:
Last Name:RASTOGI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SAN CLEMENTE CIR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8524
Mailing Address - Country:US
Mailing Address - Phone:432-570-0052
Mailing Address - Fax:432-570-0053
Practice Address - Street 1:316 SECOR ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6343
Practice Address - Country:US
Practice Address - Phone:432-570-0052
Practice Address - Fax:432-570-0053
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046756502Medicaid
TX110244676OtherRAILROAD MEDICARE
TX8AJ047OtherBCBS
TX110244676OtherRAILROAD MEDICARE
TXF61367Medicare UPIN