1205830981 NPI number — RAJENDRA DAHAL M.D.

Table of content: RAJENDRA DAHAL M.D. (NPI 1205830981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205830981 NPI number — RAJENDRA DAHAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAHAL
Provider First Name:
RAJENDRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205830981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 35TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOLINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61265-6107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-757-7780
Provider Business Mailing Address Fax Number:
309-757-7719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 35TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61265-6107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-757-7780
Provider Business Practice Location Address Fax Number:
309-757-7719
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  036088655 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 56266 . This is a "NORIDIAN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0510917 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08100343 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 90937 . This is a "WELLMARK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1136127 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0136127 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036088655 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55645 . This is a "WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0175471 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56266 . This is a "WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 93122 . This is a "WELLMARK GROUP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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