Provider Demographics
NPI:1285627885
Name:BANSAL, RAJENDRA K (MD)
Entity type:Individual
Prefix:DR
First Name:RAJENDRA
Middle Name:K
Last Name:BANSAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:875 MILITARY TRL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5700
Mailing Address - Country:US
Mailing Address - Phone:561-746-2411
Mailing Address - Fax:561-354-0012
Practice Address - Street 1:875 MILITARY TRL
Practice Address - Street 2:SUITE 200
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5700
Practice Address - Country:US
Practice Address - Phone:561-746-2411
Practice Address - Fax:561-354-0012
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2008-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0049954207R00000X, 207RG0300X
RIME0049954208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB48675Medicare UPIN
FL02697VMedicare PIN