Provider Demographics
NPI:1740253152
Name:RASTINEHAD, RUSTOM ARDESHIR (MD)
Entity type:Individual
Prefix:DR
First Name:RUSTOM
Middle Name:ARDESHIR
Last Name:RASTINEHAD
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 1:271 W CIRCULAR ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6012
Mailing Address - Country:US
Mailing Address - Phone:518-587-8421
Mailing Address - Fax:518-587-8423
Practice Address - Street 1:271 W CIRCULAR ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6012
Practice Address - Country:US
Practice Address - Phone:518-587-8421
Practice Address - Fax:518-587-8423
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1137281208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10001684OtherCDPHP
NY24108OtherMVP
NY46319OtherGHI
NY00405240001OtherBLUE SHIELD
NY95117OtherEMPIRE BLUE CROSS
NY00376178Medicaid
NY10001684OtherCDPHP
NY46319OtherGHI
NY33730BMedicare PIN