Provider Demographics
NPI:1083795298
Name:RAJENDRA K MARWAH MD PA
Entity Type:Organization
Organization Name:RAJENDRA K MARWAH MD PA
Other - Org Name:R K MARWAH MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BASSUK
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:915-822-1510
Mailing Address - Street 1:1700 CURIE DR STE 5500
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2999
Mailing Address - Country:US
Mailing Address - Phone:915-545-1158
Mailing Address - Fax:915-545-1108
Practice Address - Street 1:1600 MEDICAL CENTER DR.
Practice Address - Street 2:SUITE 314
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5008
Practice Address - Country:US
Practice Address - Phone:915-545-1158
Practice Address - Fax:915-545-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9106174400000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00D27WOtherBCBS
TX134833604Medicaid
TX00D27WOtherTX BCBS
TX660003497OtherRAILROAD MEDICARE
TX00D27WOtherBCBS
TX660003497OtherRAILROAD MEDICARE
C18911Medicare UPIN