1083795298 NPI number — RAJENDRA K MARWAH MD PA

Table of content: (NPI 1083795298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083795298 NPI number — RAJENDRA K MARWAH MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAJENDRA K MARWAH MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1083795298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 CURIE DR STE 5500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79902-2999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-545-1158
Provider Business Mailing Address Fax Number:
915-545-1108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 MEDICAL CENTER DR.
Provider Second Line Business Practice Location Address:
SUITE 314
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-5008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-545-1158
Provider Business Practice Location Address Fax Number:
915-545-1108
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BASSUK
Authorized Official First Name:
DIANNA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
915-822-1510

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  F9106 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X , with the licence number: F9106 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00D27W . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 134833604 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00D27W . This is a "TX BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 660003497 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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