Provider Demographics
NPI:1053379339
Name:RASTOGI, SHASHI P (MD)
Entity type:Individual
Prefix:DR
First Name:SHASHI
Middle Name:P
Last Name:RASTOGI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 12TH AVE
Mailing Address - Street 2:174
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3926
Mailing Address - Country:US
Mailing Address - Phone:817-348-0701
Mailing Address - Fax:817-348-0702
Practice Address - Street 1:1001. 12TH AVE.
Practice Address - Street 2:174
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7438
Practice Address - Country:US
Practice Address - Phone:817-348-0701
Practice Address - Fax:817-348-0702
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7488207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127426802Medicaid
TXC46854Medicare UPIN
TX127426802Medicaid