Healthcare Provider Details

I. General information

NPI: 1427056449
Provider Name (Legal Business Name): RAJIV S DAHIYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 08/25/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 TX-114 FRONTAGE RD SUITE 100
TROPHY CLUB TX
76262
US

IV. Provider business mailing address

2800 TX-114 FRONTAGE RD SUITE 100
TROPHY CLUB TX
76262
US

V. Phone/Fax

Practice location:
  • Phone: 817-778-4481
  • Fax: 682-237-2491
Mailing address:
  • Phone: 817-778-4481
  • Fax: 682-237-2491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberJ8504
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ8504
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberJ8504
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: