Basic Information
| Provider Information | |||||||||
| NPI: | 1437325206 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAINA | ||||||||
| FirstName: | GUNJAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RAINA | ||||||||
| OtherFirstName: | GUNJAN | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8490 PICARDY AVE | ||||||||
| Address2: | BLDG 200 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252371754 | ||||||||
| FaxNumber: | 2252371722 | ||||||||
| Practice Location | |||||||||
| Address1: | 8595 PICARDY AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257634900 | ||||||||
| FaxNumber: | 2257634938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2008 | ||||||||
| LastUpdateDate: | 09/23/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD204202 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2127659 | 05 | LA | MEDICAID |