Healthcare Provider Details

I. General information

NPI: 1770823411
Provider Name (Legal Business Name): NEERAJ V RASTOGI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2013
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 BEACON ST SUITE 3C
BROOKLINE MA
02446-3885
US

IV. Provider business mailing address

1180 BEACON ST SUITE 3C
BROOKLINE MA
02446-3885
US

V. Phone/Fax

Practice location:
  • Phone: 617-202-9222
  • Fax: 617-879-0933
Mailing address:
  • Phone: 617-202-9222
  • Fax: 617-879-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number242012
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: