Provider Demographics
NPI:1245292606
Name:TEWARI, RAJIV (MD)
Entity type:Individual
Prefix:
First Name:RAJIV
Middle Name:
Last Name:TEWARI
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 1:10995 ALLISONVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2616
Mailing Address - Country:US
Mailing Address - Phone:178-427-9283
Mailing Address - Fax:317-841-3337
Practice Address - Street 1:10995 ALLISONVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2616
Practice Address - Country:US
Practice Address - Phone:317-842-7928
Practice Address - Fax:317-841-3337
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052497A208VP0000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200286720Medicaid
IN170580VMedicare PIN
IN200286720Medicaid