Provider Demographics
NPI:1093733941
Name:VACHHARAJANI, TUSHAR JITENDRA (MD)
Entity type:Individual
Prefix:
First Name:TUSHAR
Middle Name:JITENDRA
Last Name:VACHHARAJANI
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:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023911207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
191659OtherMEDCOST
NC5905800Medicaid
782081OtherAETNA
143GWOtherBCBS
LA1572110Medicaid
VA10389844Medicaid
WV3810007243Medicaid
808444OtherPARTNERS
191659OtherMEDCOST
NC2063481AMedicare PIN
782081OtherAETNA
143GWOtherBCBS