Provider Demographics
NPI:1205830981
Name:DAHAL, RAJENDRA (MD)
Entity Type:Individual
Prefix:
First Name:RAJENDRA
Middle Name:
Last Name:DAHAL
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 1:615 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6107
Mailing Address - Country:US
Mailing Address - Phone:309-757-7780
Mailing Address - Fax:309-757-7719
Practice Address - Street 1:615 35TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6107
Practice Address - Country:US
Practice Address - Phone:309-757-7780
Practice Address - Fax:309-757-7719
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088655207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA56266OtherNORIDIAN
IA0510917Medicaid
IL08100343OtherBLUE CROSS BLUE SHIELD
IL90937OtherWELLMARK
IA1136127Medicaid
IA0136127Medicaid
IL036088655Medicaid
IA55645OtherWELLMARK
IA0175471Medicaid
IA56266OtherWELLMARK
IL93122OtherWELLMARK GROUP
IL08100343OtherBLUE CROSS BLUE SHIELD
IA1136127Medicaid
IL305250Medicare PIN
ILL61225Medicare ID - Type Unspecified