Provider Demographics
NPI:1669762803
Name:BANSAL, RACHITA (MD)
Entity type:Individual
Prefix:
First Name:RACHITA
Middle Name:
Last Name:BANSAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RACHITA
Other - Middle Name:
Other - Last Name:GARG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4613 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-1705
Mailing Address - Country:US
Mailing Address - Phone:407-232-9833
Mailing Address - Fax:407-232-9829
Practice Address - Street 1:4613 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-1705
Practice Address - Country:US
Practice Address - Phone:407-232-9833
Practice Address - Fax:407-232-9829
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME155739207R00000X
PAMD452329208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice