Provider Demographics
NPI:1437148749
Name:RAJVANSHI, PANKAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:PANKAJ
Middle Name:
Last Name:RAJVANSHI
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 1:4011 TALBOT RD S STE 500
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5782
Mailing Address - Country:US
Mailing Address - Phone:425-690-3488
Mailing Address - Fax:425-690-9088
Practice Address - Street 1:4011 TALBOT RD S STE 500
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5782
Practice Address - Country:US
Practice Address - Phone:425-690-3488
Practice Address - Fax:425-690-9088
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036106207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1010326Medicaid
WA8240251Medicaid
WA1437148749Medicaid
WA1010326Medicaid
WA8240251Medicaid