Provider Demographics
NPI:1730195397
Name:INGLE, RAJENDRAKUMAR RAGHUNATH (MD)
Entity type:Individual
Prefix:
First Name:RAJENDRAKUMAR
Middle Name:RAGHUNATH
Last Name:INGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 W WASHINGTON AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4337
Mailing Address - Country:US
Mailing Address - Phone:877-562-5227
Mailing Address - Fax:702-938-9954
Practice Address - Street 1:4230 BURNHAM AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119
Practice Address - Country:US
Practice Address - Phone:702-733-7866
Practice Address - Fax:702-792-1319
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9606207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV111391Medicare PIN
AZZ182512Medicare PIN