Provider Demographics
NPI:1255398194
Name:DWIVEDI, ROHIT (MD)
Entity type:Individual
Prefix:DR
First Name:ROHIT
Middle Name:
Last Name:DWIVEDI
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 1:12361 W BOLA DR STE 109
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9021
Mailing Address - Country:US
Mailing Address - Phone:623-227-1000
Mailing Address - Fax:623-227-2000
Practice Address - Street 1:12361 W BOLA DR STE 109
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9021
Practice Address - Country:US
Practice Address - Phone:623-227-1000
Practice Address - Fax:623-227-2000
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30335207RE0101X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00067262OtherRAILROAD MEDICARE
AZP00626610OtherRAILROAD
AZAZ0715850OtherBLUE CROSS
AZZ69511Medicare PIN
AZG88377Medicare UPIN
AZZ120736Medicare PIN