Provider Demographics
NPI:1548478266
Name:AMIT K. RAJVANSHI MD PC
Entity type:Organization
Organization Name:AMIT K. RAJVANSHI MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAJVANSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-881-0230
Mailing Address - Street 1:9461 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4633
Mailing Address - Country:US
Mailing Address - Phone:301-881-0230
Mailing Address - Fax:301-770-0207
Practice Address - Street 1:121 CONGRESSIONAL LN
Practice Address - Street 2:SUITE 409
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1542
Practice Address - Country:US
Practice Address - Phone:301-881-0230
Practice Address - Fax:301-770-0207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC025915400Medicaid
MD401255100Medicaid
DC025915400Medicaid
MDG02482Medicare PIN