Provider Demographics
NPI:1538125992
Name:RASTOGI, PALLAVI MARATHE (MD)
Entity Type:Individual
Prefix:DR
First Name:PALLAVI
Middle Name:MARATHE
Last Name:RASTOGI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PALLAVI
Other - Middle Name:
Other - Last Name:MARATHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:255 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1763
Mailing Address - Country:US
Mailing Address - Phone:484-565-1600
Mailing Address - Fax:610-647-2006
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1763
Practice Address - Country:US
Practice Address - Phone:484-565-1600
Practice Address - Fax:610-647-2006
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425319207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA098995HK1Medicare PIN
PA23-2359401OtherMAIN LINE HEALTHCARE TAX ID