Provider Demographics
NPI:1740328657
Name:KALYANI, RITA RASTOGI (MD)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:RASTOGI
Last Name:KALYANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:RASTOGI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-3663
Practice Address - Fax:410-955-8172
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRES-000207RE0101X
MDD65784207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036422300Medicaid
MD18674ZAC3Medicare PIN