Healthcare Provider Details

I. General information

NPI: 1134487135
Provider Name (Legal Business Name): RAHUL VANJANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 PINE ST
PROVIDENCE RI
02907-1358
US

IV. Provider business mailing address

460 PINE ST
PROVIDENCE RI
02907-1358
US

V. Phone/Fax

Practice location:
  • Phone: 401-272-0220
  • Fax: 401-252-8410
Mailing address:
  • Phone: 401-272-0220
  • Fax: 401-252-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD15794
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD15794
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberMD15794
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: