Provider Demographics
NPI:1881709657
Name:BHUSHAN, RAJAT
Entity type:Individual
Prefix:DR
First Name:RAJAT
Middle Name:
Last Name:BHUSHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9808 BLUEBONNET BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-6442
Mailing Address - Country:US
Mailing Address - Phone:225-763-9050
Mailing Address - Fax:225-763-9335
Practice Address - Street 1:9808 BLUEBONNET BLVD
Practice Address - Street 2:STE 200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-6442
Practice Address - Country:US
Practice Address - Phone:225-763-9050
Practice Address - Fax:866-777-2309
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.07843R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1385956Medicaid
LABB83173Medicare UPIN
LA1385956Medicaid