Provider Demographics
NPI:1699914564
Name:VALVANI, RAJEEV KUMAR (DO)
Entity type:Individual
Prefix:DR
First Name:RAJEEV
Middle Name:KUMAR
Last Name:VALVANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:RAJ
Other - Middle Name:KUMAR
Other - Last Name:VALVANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:300 TOWER ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-9403
Mailing Address - Country:US
Mailing Address - Phone:770-427-5717
Mailing Address - Fax:770-514-5040
Practice Address - Street 1:300 TOWER ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9403
Practice Address - Country:US
Practice Address - Phone:770-427-5717
Practice Address - Fax:770-514-5040
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA070599208100000X
MI5101017939208100000X
NY264247208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA070599OtherSTATE MEDICAL LICENSE