Provider Demographics
NPI:1063486090
Name:RUSTAGI, RAVINDER K (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVINDER
Middle Name:K
Last Name:RUSTAGI
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 1:6132 LANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1022
Mailing Address - Country:US
Mailing Address - Phone:301-386-2666
Mailing Address - Fax:301-386-2085
Practice Address - Street 1:6132 LANDOVER RD
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1022
Practice Address - Country:US
Practice Address - Phone:301-386-2666
Practice Address - Fax:301-386-2085
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024720207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD294741200Medicaid
MD294741200Medicaid
MDB94757Medicare UPIN