Provider Demographics
NPI:1023137023
Name:RATH, TANYA JAITLEY (MD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:JAITLEY
Last Name:RATH
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 1:13400 E SHEA BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5499
Mailing Address - Country:US
Mailing Address - Phone:480-301-8000
Mailing Address - Fax:
Practice Address - Street 1:13400 E SHEA BLVD STE 600
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5499
Practice Address - Country:US
Practice Address - Phone:480-301-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ582422085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34944300Medicaid
MN960371051853OtherPREFERRED ONE
MN134874OtherUCARE
MNHP80930OtherHEALTHPARTNERS
MN254398OtherMIDLANDS CHOICE INC
MN54R72RAOtherBLUE CROSS AND BLUE SHIELD OF MN
MN332452000Medicaid
MN03M79RAOtherBLUE CROSS AND BLUE SHIELD OF MN
MN9252111OtherDAKOTA CARE
MNP00450346Medicare PIN
MN134874OtherUCARE
MNHP80930OtherHEALTHPARTNERS
MN03M79RAOtherBLUE CROSS AND BLUE SHIELD OF MN
MN300004348Medicare PIN
MN006056135Medicare PIN