Provider Demographics
NPI:1528077732
Name:RATHI, DWARKA (MD)
Entity type:Individual
Prefix:
First Name:DWARKA
Middle Name:
Last Name:RATHI
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 1:1561 TRYON RD NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2940
Mailing Address - Country:US
Mailing Address - Phone:146-433-8799
Mailing Address - Fax:
Practice Address - Street 1:1561 TRYON RD NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-2940
Practice Address - Country:US
Practice Address - Phone:914-643-3879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86856207RN0300X
NY205041-1207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01577820Medicaid
F97358Medicare UPIN
NY01577820Medicaid