Provider Demographics
NPI:1790783538
Name:HANDA, RAJIV R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:R
Last Name:HANDA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10012 KENNERLY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-692-2807
Mailing Address - Fax:314-991-0727
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-692-2807
Practice Address - Fax:314-991-0727
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2016-05-23
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Provider Licenses
StateLicense IDTaxonomies
MO2004010191207RC0000X
MO199566207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208799601Medicaid
MO208799601Medicaid
MOMA3163012Medicare PIN
P00144759Medicare PIN