Healthcare Provider Details

I. General information

NPI: 1063486090
Provider Name (Legal Business Name): RAVINDER K RUSTAGI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6132 LANDOVER RD
CHEVERLY MD
20785-1022
US

IV. Provider business mailing address

6132 LANDOVER RD
CHEVERLY MD
20785-1022
US

V. Phone/Fax

Practice location:
  • Phone: 301-386-2666
  • Fax: 301-386-2085
Mailing address:
  • Phone: 301-386-2666
  • Fax: 301-386-2085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0024720
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: