Provider Demographics
NPI:1457799231
Name:RAWAL, ROUNAK BABULA (MD)
Entity Type:Individual
Prefix:MR
First Name:ROUNAK
Middle Name:BABULA
Last Name:RAWAL
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 1:230 BOSTON POST ROAD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2225
Mailing Address - Country:US
Mailing Address - Phone:203-245-0496
Mailing Address - Fax:203-245-8697
Practice Address - Street 1:230 BOSTON POST ROAD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2225
Practice Address - Country:US
Practice Address - Phone:203-245-0496
Practice Address - Fax:203-245-8697
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC191818390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program