Healthcare Provider Details

I. General information

NPI: 1902268964
Provider Name (Legal Business Name): PRAJAKTA VIJAYSINGH RAJPUT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TAYLOR RD
MONTGOMERY AL
36117-3512
US

IV. Provider business mailing address

9262 SPRINGWOOD CT
MONTGOMERY AL
36117-8464
US

V. Phone/Fax

Practice location:
  • Phone: 334-277-8330
  • Fax:
Mailing address:
  • Phone: 334-462-6024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.37326
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: