Provider Demographics
NPI:1033167986
Name:JITAN, RAED A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAED
Middle Name:A
Last Name:JITAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15 MCCAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2291
Mailing Address - Country:US
Mailing Address - Phone:732-946-0995
Mailing Address - Fax:732-946-0995
Practice Address - Street 1:15 MCCAMPBELL RD
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-2291
Practice Address - Country:US
Practice Address - Phone:732-946-0995
Practice Address - Fax:732-946-0995
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07843100207RC0000X
WV17922207RC0000X
KY31939207RC0000X
OH84811207RC0000X
SC20531207RC0000X
AL23877207RC0000X
IA29166207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0078319000Medicaid
KY64319395Medicaid
OH0176401Medicaid
KY64319395Medicaid
WV0078319000Medicaid
WVJI408911Medicare PIN