Provider Demographics
NPI:1477535680
Name:SOMVANSHI, RAHUL ARVIND (MD)
Entity Type:Individual
Prefix:
First Name:RAHUL
Middle Name:ARVIND
Last Name:SOMVANSHI
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 1:2825 OAK LAWN AVE UNIT 192749
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4688
Mailing Address - Country:US
Mailing Address - Phone:844-389-5711
Mailing Address - Fax:877-880-2039
Practice Address - Street 1:2825 OAK LAWN AVE UNIT 192749
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4688
Practice Address - Country:US
Practice Address - Phone:844-389-5711
Practice Address - Fax:877-880-2039
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD117172085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
9352589OtherPHHCS
7057393OtherRIMEDICAL ASSISTANCE
RI7057393Medicaid
MA2102005Medicaid
2102005OtherMASSMEDICAID
AA31529OtherAETNA
2102005OtherMASSMEDICAID
RI7057393Medicaid