Provider Demographics
NPI:1730264854
Name:RAI, NIRMAL S (MD)
Entity type:Individual
Prefix:
First Name:NIRMAL
Middle Name:S
Last Name:RAI
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 1:1930 E HATCH RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-5141
Mailing Address - Country:US
Mailing Address - Phone:209-531-0552
Mailing Address - Fax:209-537-4493
Practice Address - Street 1:1930 E HATCH RD
Practice Address - Street 2:STE A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-5141
Practice Address - Country:US
Practice Address - Phone:209-531-0552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A490250Medicaid
CA00A490250Medicaid
CA00A490250Medicare PIN
CA6687350001Medicare NSC