Provider Demographics
NPI:1659767051
Name:RATHORE, MAANJOT
Entity Type:Individual
Prefix:
First Name:MAANJOT
Middle Name:
Last Name:RATHORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 SOUTH GRAND
Mailing Address - Street 2:FDT 14TH FLOOR
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104
Mailing Address - Country:US
Mailing Address - Phone:314-577-8762
Mailing Address - Fax:314-577-8100
Practice Address - Street 1:1402 SOUTH GRAND
Practice Address - Street 2:FDT 14TH FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104
Practice Address - Country:US
Practice Address - Phone:314-577-8762
Practice Address - Fax:314-577-8100
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015019348207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine