Provider Demographics
NPI:1295782100
Name:RASTOGI, AMIT (MD)
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:RASTOGI
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 1:253 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7560
Mailing Address - Country:US
Mailing Address - Phone:603-226-6108
Mailing Address - Fax:603-229-5111
Practice Address - Street 1:253 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7560
Practice Address - Country:US
Practice Address - Phone:603-226-6108
Practice Address - Fax:603-229-5111
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086749207R00000X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00325179OtherRAILROAD MEDICARE
NH3074811Medicaid
OH2650644Medicaid
NH001240401Medicare PIN
OH2650644Medicaid
I52522Medicare UPIN