Provider Demographics
NPI:1831196583
Name:GOEL, RAJIV (MD)
Entity type:Individual
Prefix:
First Name:RAJIV
Middle Name:
Last Name:GOEL
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 1:4616 25TH AVE NE
Mailing Address - Street 2:BOX 739
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4183
Mailing Address - Country:US
Mailing Address - Phone:206-257-3350
Mailing Address - Fax:206-257-3352
Practice Address - Street 1:901 BOREN AVE STE 711
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3301
Practice Address - Country:US
Practice Address - Phone:206-257-3350
Practice Address - Fax:206-257-3352
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041304207XS0106X, 207X00000X, 207XS0106X
WA41304207X00000X
IN01062919A207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN90001242OtherBCBS OF ILLINOIS
IN000000534722OtherANTHEM BCBS
IN200880990Medicaid
IN233110HMedicare PIN
IN90001242OtherBCBS OF ILLINOIS