Provider Demographics
NPI:1194766220
Name:WALSH, RAJANI S (MD)
Entity type:Individual
Prefix:
First Name:RAJANI
Middle Name:S
Last Name:WALSH
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 1:41 UNIVERSITY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-7037
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:100 TOWNSEND AVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009
Practice Address - Country:US
Practice Address - Phone:856-322-3260
Practice Address - Fax:856-322-3061
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA39648207P00000X
PAMD028249E207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014803490004Medicaid
PA1194766220OtherKEYSTONE IBC
PA1367087OtherCIGNA PA
NJ1926403Medicaid
PA2663312OtherHIGHMARK BLUE SHIELD
PA4203863OtherAETNA
PA1194766220OtherKEYSTONE IBC
PA1367087OtherCIGNA PA