Provider Demographics
NPI:1881859247
Name:RATHORE, BHAWANA (MD)
Entity type:Individual
Prefix:
First Name:BHAWANA
Middle Name:
Last Name:RATHORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RIVERVIEW DR # 104
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6268
Mailing Address - Country:US
Mailing Address - Phone:203-739-7532
Mailing Address - Fax:
Practice Address - Street 1:2 RIVERVIEW DR # 104
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6268
Practice Address - Country:US
Practice Address - Phone:203-739-7532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD460984207U00000X
PAMT2046062085R0202X
CT565762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103318349Medicaid