Provider Demographics
NPI:1427047885
Name:RASTOGI, ARCHANA (MD)
Entity type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:
Last Name:RASTOGI
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 1:7583 WALL TRIANA HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757-8327
Mailing Address - Country:US
Mailing Address - Phone:256-830-5777
Mailing Address - Fax:256-546-2981
Practice Address - Street 1:5107 MOORES MILL RD
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35811-1007
Practice Address - Country:US
Practice Address - Phone:256-851-7190
Practice Address - Fax:256-851-7189
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00021023207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51005125OtherBLUE CROSS BLUE SHIELD
AL51005127OtherBLUE CROSS BLUE SHIELD
AL009942017Medicaid
AL051558657OtherMEDICARE
AL51005125OtherBLUE CROSS BLUE SHIELD
G60309Medicare UPIN