Provider Demographics
NPI:1598721029
Name:DEWAN, RAHUL (MD)
Entity Type:Individual
Prefix:
First Name:RAHUL
Middle Name:
Last Name:DEWAN
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 1:550 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-3027
Mailing Address - Country:US
Mailing Address - Phone:540-316-5540
Mailing Address - Fax:403-165-5805
Practice Address - Street 1:550 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3027
Practice Address - Country:US
Practice Address - Phone:540-316-5540
Practice Address - Fax:540-316-5580
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2006-01882084S0012X, 2084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP00340242OtherRAILROAD MEDICARE
FL003003300Medicaid
NM00NM1H88OtherBCBS
NM65232569Medicaid
NM346618102Medicare PIN
NMI53587Medicare UPIN
NMNM303309Medicare PIN