Provider Demographics
NPI:1952307506
Name:RATHOD, DHANVANT M (MD)
Entity Type:Individual
Prefix:
First Name:DHANVANT
Middle Name:M
Last Name:RATHOD
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 1:11 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-3325
Mailing Address - Country:US
Mailing Address - Phone:207-255-3356
Mailing Address - Fax:207-255-0289
Practice Address - Street 1:11 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-3325
Practice Address - Country:US
Practice Address - Phone:207-255-3356
Practice Address - Fax:207-255-0289
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016789208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME424200099Medicaid
ME061109OtherANTHEM
ME3685557OtherAETNA
ME424200099Medicaid
ME3685557OtherAETNA