1417944190 NPI number — DR. RAJNISH BANSAL MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417944190 NPI number — DR. RAJNISH BANSAL MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BANSAL

Provider First Name:

RAJNISH

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1417944190

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/02/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

10 DAVOL SQ

Provider Second Line Business Mailing Address:

STE 400

Provider Business Mailing Address City Name:

PROVIDENCE

Provider Business Mailing Address State Name:

RI

Provider Business Mailing Address Postal Code:

02903-4754

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

401-421-4000

Provider Business Mailing Address Fax Number:

401-272-1456

Provider First Line Business Practice Location Address:

900 WARREN AVE

Provider Second Line Business Practice Location Address:

STE 400

Provider Business Practice Location Address City Name:

EAST PROVIDENCE

Provider Business Practice Location Address State Name:

RI

Provider Business Practice Location Address Postal Code:

02914-1430

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

401-331-1221

Provider Business Practice Location Address Fax Number:

401-751-8003

Provider Enumeration Date:

09/29/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  MD10218 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 10240 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 406635 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 04-02810 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 0540483739 . This is a "GREAT WEST HEALTH CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 110193084 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 710046201 . This is a "CIGNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 69821 . This is a "HARVARD HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 709004159 . This is a "MEDICARE GROUP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 22011 . This is a "BCBS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 402478 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 9022011 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".