Provider Demographics
NPI:1659375459
Name:RATHOR, ABDUL L (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:L
Last Name:RATHOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 SUMMIT ST
Mailing Address - Street 2:STE 1
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1645
Mailing Address - Country:US
Mailing Address - Phone:585-343-4440
Mailing Address - Fax:585-343-0381
Practice Address - Street 1:229 SUMMIT ST
Practice Address - Street 2:STE 1
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1645
Practice Address - Country:US
Practice Address - Phone:585-343-4440
Practice Address - Fax:585-343-0381
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY114812207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00468144Medicaid
NYB36008Medicare UPIN
NY00468144Medicaid