Provider Demographics
NPI:1881709699
Name:RUSTAGI, PRADIP K (MD)
Entity type:Individual
Prefix:
First Name:PRADIP
Middle Name:K
Last Name:RUSTAGI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 TRUXTUN AVE
Mailing Address - Street 2:STE 275
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0633
Mailing Address - Country:US
Mailing Address - Phone:650-988-8011
Mailing Address - Fax:650-988-8012
Practice Address - Street 1:2500 NE NEFF RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6015
Practice Address - Country:US
Practice Address - Phone:541-706-5800
Practice Address - Fax:541-706-5911
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG083670207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G836700Medicare ID - Type UnspecifiedMEDICARE PROVIDER NR