Provider Demographics
NPI:1508817107
Name:BAJWA, RAGHUBINDER K (MD)
Entity Type:Individual
Prefix:DR
First Name:RAGHUBINDER
Middle Name:K
Last Name:BAJWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 BLUE HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112
Mailing Address - Country:US
Mailing Address - Phone:608-714-2647
Mailing Address - Fax:860-714-8517
Practice Address - Street 1:490 BLUE HILLS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112
Practice Address - Country:US
Practice Address - Phone:608-714-2647
Practice Address - Fax:608-714-8517
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT29145207Q00000X
MA60569208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3051323Medicaid
MAJ08214OtherBLUE CROSS BLUE SHIELD
MAJ08214Medicare PIN
MAJ08214OtherBLUE CROSS BLUE SHIELD