Provider Demographics
NPI:1851650998
Name:RAWAL, PRITY (MD)
Entity Type:Individual
Prefix:
First Name:PRITY
Middle Name:
Last Name:RAWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 LAKEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-9762
Mailing Address - Country:US
Mailing Address - Phone:585-243-1400
Mailing Address - Fax:585-243-0518
Practice Address - Street 1:4400 LAKEVILLE RD
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-9762
Practice Address - Country:US
Practice Address - Phone:585-243-1400
Practice Address - Fax:585-243-0518
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280612207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04204028Medicaid