Healthcare Provider Details

I. General information

NPI: 1982263224
Provider Name (Legal Business Name): YASIR RAFIQUE RAJWANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date: 01/17/2020
Reactivation Date: 12/03/2020

III. Provider practice location address

410 CELEBRATION PL
CELEBRATION FL
34747-5433
US

IV. Provider business mailing address

410 CELEBRATION PL STE 106
CELEBRATION FL
34747-5432
US

V. Phone/Fax

Practice location:
  • Phone: 646-334-6474
  • Fax:
Mailing address:
  • Phone: 646-334-6474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME178071
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: