1225218167 NPI number — RAHUL DIXIT M.D.

Table of content: RAHUL DIXIT M.D. (NPI 1225218167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225218167 NPI number — RAHUL DIXIT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIXIT
Provider First Name:
RAHUL
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:
1225218167
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1309 SMYRNA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40513-1754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-521-8576
Provider Business Mailing Address Fax Number:
606-280-7570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 TRILLIUM WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-8426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-521-8576
Provider Business Practice Location Address Fax Number:
606-280-7570
Provider Enumeration Date:
11/08/2007

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: 208100000X , with the licence number:  28238 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 64282387 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 28238 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000187164 . This is a "BLUE CROSS & BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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