Healthcare Provider Details

I. General information

NPI: 1588074231
Provider Name (Legal Business Name): RAJENDRA N PAHWA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2014
Last Update Date: 05/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 CRANDON BLVD APT 1207
KEY BISCAYNE FL
33149-2557
US

IV. Provider business mailing address

799 CRANDON BLVD APT 1207
KEY BISCAYNE FL
33149-2557
US

V. Phone/Fax

Practice location:
  • Phone: 305-365-8653
  • Fax:
Mailing address:
  • Phone: 305-365-8653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME92853
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: