Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | C1-0006294 | DE |
N | 207T00000X | Neurosurgeon | C10006294 | DE |
N | 207T00000X | Neurosurgeon | D0057496 | MD |
NPI | 1073611968 |
---|---|
Provider Name | Pawan Rastogi |
First Address | Newark, DE 19713 |
Second Address | Newark, DE 19713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 13/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001164901 | (05) | DE |
H42647 | (02) | |
P00066875 | RAILROAD MEDICARE PIN (01) | DE |