MEDICARE: DR. MITRA RAJABI HANJANI M.D.

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	207R00000X	Internal Medicine Physician	MD60744384	WA

General Provider Information

NPI Number	:	1881897601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITRA RAJABI HANJANI M.D.

Provider Business Mailing Address
First Line	:	4114 BRIDGEPORT WAY W
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4315
Country	:	US
Telephone Number	:	832-349-6226
Fax Number	:	252-220-2491

Provider Business Practice Location Address
First Line	:	4401 BRIDGEPORT WAY W
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4201
Country	:	US
Telephone Number	:	253-564-4157
Fax Number	:

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

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	07/27/2023

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