Provider Demographics
NPI:1326227042
Name:RAJNIKANT KUSHWAHA MD PA
Entity type:Organization
Organization Name:RAJNIKANT KUSHWAHA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJNIKANT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHWAHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-273-4666
Mailing Address - Street 1:150 PINE FOREST DR
Mailing Address - Street 2:SUITE 604
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-5302
Mailing Address - Country:US
Mailing Address - Phone:936-273-4666
Mailing Address - Fax:936-271-4666
Practice Address - Street 1:150 PINE FOREST DR STE 604
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-5304
Practice Address - Country:US
Practice Address - Phone:936-273-4666
Practice Address - Fax:936-271-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7323207R00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00001133OtherMEDICARE RAILROAD
TX158357701Medicaid
TX158357701Medicaid