Provider Demographics
NPI:1881897601
Name:HANJANI, MITRA RAJABI (MD)
Entity type:Individual
Prefix:DR
First Name:MITRA
Middle Name:RAJABI
Last Name:HANJANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MITRA
Other - Middle Name:R
Other - Last Name:HANJANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4114 BRIDGEPORT WAY W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4315
Mailing Address - Country:US
Mailing Address - Phone:832-349-6226
Mailing Address - Fax:252-220-2491
Practice Address - Street 1:4401 BRIDGEPORT WAY W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4201
Practice Address - Country:US
Practice Address - Phone:253-564-4157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60744384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty