Provider Demographics
NPI:1710930672
Name:RAWAT, SUMANT (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMANT
Middle Name:
Last Name:RAWAT
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 1:1925 E ORMAN AVE
Mailing Address - Street 2:SUITE G32
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3537
Mailing Address - Country:US
Mailing Address - Phone:719-564-0883
Mailing Address - Fax:719-564-0861
Practice Address - Street 1:1925 E ORMAN AVE
Practice Address - Street 2:SUITE G32
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3537
Practice Address - Country:US
Practice Address - Phone:719-564-0883
Practice Address - Fax:719-564-0861
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25271174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01252717Medicaid
CO01252717Medicaid
COC801941Medicare PIN