Provider Demographics
NPI:1376599852
Name:RAJAWAT, YADAVENDRA S (MD)
Entity Type:Individual
Prefix:
First Name:YADAVENDRA
Middle Name:S
Last Name:RAJAWAT
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 1:160 GALLERY DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2690
Mailing Address - Country:US
Mailing Address - Phone:724-260-7400
Mailing Address - Fax:724-260-7410
Practice Address - Street 1:160 GALLERY DR
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-2690
Practice Address - Country:US
Practice Address - Phone:724-260-7400
Practice Address - Fax:724-260-7410
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227917207R00000X
PAMD417592207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0087548Medicaid
PA1020386180001Medicaid
PAI74084Medicare UPIN
PA1020386180001Medicaid