Provider Demographics
NPI:1790791036
Name:MOMI, RAJINDER S (MD)
Entity Type:Individual
Prefix:
First Name:RAJINDER
Middle Name:S
Last Name:MOMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PETERBOROUGH REGIONAL HEALTH CENTRE, DEPT OF PSYCHIATRY
Mailing Address - Street 2:1 HOSPITAL DRIVE
Mailing Address - City:PETERBOROUGH
Mailing Address - State:ON
Mailing Address - Zip Code:K9J 7C6
Mailing Address - Country:CA
Mailing Address - Phone:705-876-5028
Mailing Address - Fax:715-876-5013
Practice Address - Street 1:PETERBOROUGH REGIONAL HEALTH CENTRE, DEPT OF PSYCHIATRY
Practice Address - Street 2:1 HOSPITAL DRIVE
Practice Address - City:PETERBOROUGH
Practice Address - State:ON
Practice Address - Zip Code:K9J 7C6
Practice Address - Country:CA
Practice Address - Phone:705-876-5028
Practice Address - Fax:715-876-5013
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI488292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34886500Medicaid
WI34886500Medicaid