Healthcare Provider Details

I. General information

NPI: 1942934492
Provider Name (Legal Business Name): RAJAT KANTI LAHIRI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date: 03/28/2023
Reactivation Date: 04/06/2023

III. Provider practice location address

2287 MOWRY AVE STE A
FREMONT CA
94538-1622
US

IV. Provider business mailing address

PO BOX 25576
BELFAST ME
04915-2006
US

V. Phone/Fax

Practice location:
  • Phone: 510-796-3267
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: