Provider Demographics
NPI:1275624231
Name:GARG, RAJEEV (MD)
Entity Type:Individual
Prefix:
First Name:RAJEEV
Middle Name:
Last Name:GARG
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 1:9520 W PALM LN STE 150
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4454
Mailing Address - Country:US
Mailing Address - Phone:602-584-5444
Mailing Address - Fax:602-584-6202
Practice Address - Street 1:9520 W PALM LN STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4454
Practice Address - Country:US
Practice Address - Phone:602-584-5444
Practice Address - Fax:602-584-6202
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT2006009442207R00000X
AZ43149207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ538630Medicaid
AZZ139911Medicare PIN