Provider Demographics
NPI:1912968728
Name:NATH, RAJNEESH (MD)
Entity Type:Individual
Prefix:
First Name:RAJNEESH
Middle Name:
Last Name:NATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:55 LAKE AVE N
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01655-0002
Mailing Address - Country:US
Mailing Address - Phone:774-442-3903
Mailing Address - Fax:774-443-7890
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:774-442-3903
Practice Address - Fax:774-443-7890
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237787207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1015504OtherMEDICARE VT
MA1912968728OtherTUFTS
MA1912968728OtherBLUE CROSS BLUE SHIELD
MAPVN 1935556OtherAETNA US HEALTHCARE
MA1912968728OtherFALLON
MA2160536Medicaid
MARN 72782OtherMEDICARE RI
MA000765501OtherMEDICARE PART B
MA1912968728OtherMEDICARE CT
MA2160536Medicaid