Provider Demographics
NPI:1306884986
Name:RASTOGI, ASHUTOSH (MD)
Entity type:Individual
Prefix:DR
First Name:ASHUTOSH
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:301 N N ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6404
Practice Address - Country:US
Practice Address - Phone:432-685-1559
Practice Address - Fax:432-683-6973
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8447207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103714502Medicaid
TX103714504Medicaid
TX8R1529OtherBLUE CROSS OF TEXAS
H21356Medicare UPIN
TX830006991Medicare PIN
TX103714504Medicaid
TX8R1529OtherBLUE CROSS OF TEXAS