Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | 0401412038 | VA |
Y | 1223P0300X | Periodontist | 14431 | MD |
NPI | 1154586162 |
---|---|
Provider Name | Dr. Amal Rastogi |
First Address | Waldorf, MD 20601-3114 |
Second Address | Waldorf, MD 20601-3114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2008 |
Last Update Date | 20/01/2010 |