Provider Demographics
NPI:1447413984
Name:PANT, PRAJWOL RAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAJWOL
Middle Name:RAJ
Last Name:PANT
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2900 LAMB CIR
Mailing Address - Street 2:SUITE 190
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6344
Mailing Address - Country:US
Mailing Address - Phone:540-633-5650
Mailing Address - Fax:540-633-5659
Practice Address - Street 1:2900 LAMB CIR
Practice Address - Street 2:SUITE 190
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6344
Practice Address - Country:US
Practice Address - Phone:540-633-5650
Practice Address - Fax:540-633-5659
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125053471207R00000X
MI4301100124207R00000X
VA0101258128207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1463002Medicare PIN