Provider Demographics
NPI:1457458648
Name:RASTOGI, VIJAY (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:
Last Name:RASTOGI
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 1:20050 HARVARD AVE
Mailing Address - Street 2:#304 CHARLES MINER BLDG
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6816
Mailing Address - Country:US
Mailing Address - Phone:216-283-0750
Mailing Address - Fax:216-491-6374
Practice Address - Street 1:20050 HARVARD AVE
Practice Address - Street 2:#304 CHARLES MINER BLDG
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6816
Practice Address - Country:US
Practice Address - Phone:216-283-0750
Practice Address - Fax:216-491-6374
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075697R207R00000X
OH35-075697207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2181697Medicaid
OH4067321Medicare PIN
OHP00653178Medicare PIN
OHH18252Medicare UPIN
OHRA4067322Medicare PIN