MEDICARE: RAVI K RAHEJA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	35328	TN

General Provider Information

NPI Number	:	1801880174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVI K RAHEJA MD

Provider Business Mailing Address
First Line	:	1351 WESTGATE CENTER DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-2934
Country	:	US
Telephone Number	:	336-718-7777
Fax Number	:	336-718-7744

Provider Business Practice Location Address
First Line	:	1351 WESTGATE CENTER DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-2934
Country	:	US
Telephone Number	:	336-718-7777
Fax Number	:	336-718-7744

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	04/02/2008

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