Provider Demographics
NPI:1205369444
Name:MOMAN, RAJAT NISHANT (MD)
Entity type:Individual
Prefix:
First Name:RAJAT
Middle Name:NISHANT
Last Name:MOMAN
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 1:8136 CENTRALIA CT STE 103
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3757
Mailing Address - Country:US
Mailing Address - Phone:352-343-7246
Mailing Address - Fax:
Practice Address - Street 1:8136 CENTRALIA CT STE 103
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3757
Practice Address - Country:US
Practice Address - Phone:352-343-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28975207L00000X
MN64155207L00000X
FLME155653207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology