Provider Demographics
NPI:1578500518
Name:AGGARWAL, RAJENDRA K (MD)
Entity Type:Individual
Prefix:
First Name:RAJENDRA
Middle Name:K
Last Name:AGGARWAL
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 1:3535 SALEM AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-2645
Mailing Address - Country:US
Mailing Address - Phone:937-274-0040
Mailing Address - Fax:937-275-1750
Practice Address - Street 1:3535 SALEM AVE
Practice Address - Street 2:STE 201
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-2645
Practice Address - Country:US
Practice Address - Phone:937-274-0040
Practice Address - Fax:937-275-1750
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.043655208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0396692Medicaid
OH4243249Medicare PIN
OH0396692Medicaid
OH0469844Medicare PIN
OH0469845Medicare PIN