Provider Demographics
NPI:1528180551
Name:RAVINDER K RUSTAGI M.D.P.A
Entity Type:Organization
Organization Name:RAVINDER K RUSTAGI M.D.P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVINDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:RUSTAGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-386-2666
Mailing Address - Street 1:9333 BELLE TERRE WAY
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4643
Mailing Address - Country:US
Mailing Address - Phone:301-765-2256
Mailing Address - Fax:301-765-3369
Practice Address - Street 1:6132 LANDOVER RD
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1022
Practice Address - Country:US
Practice Address - Phone:301-386-2666
Practice Address - Fax:301-386-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD24720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty