Provider Demographics
NPI:1073611968
Name:RASTOGI, PAWAN (MD)
Entity type:Individual
Prefix:
First Name:PAWAN
Middle Name:
Last Name:RASTOGI
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 1:774 CHRISTIANA ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-366-7671
Mailing Address - Fax:302-366-7549
Practice Address - Street 1:774 CHRISTIANA ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-366-7671
Practice Address - Fax:302-366-7549
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006294207T00000X
MDD0057496207T00000X
DEC1-0006294207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP00066875OtherRAILROAD MEDICARE PIN
DE0001164901Medicaid
H42647Medicare UPIN
DE007728M04Medicare PIN
MD456P887GMedicare PIN