Provider Demographics
NPI:1114958618
Name:PATEL, RAKESH R (DO)
Entity Type:Individual
Prefix:DR
First Name:RAKESH
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4548
Mailing Address - Country:US
Mailing Address - Phone:814-941-3326
Mailing Address - Fax:814-941-3279
Practice Address - Street 1:2005 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4548
Practice Address - Country:US
Practice Address - Phone:814-941-3326
Practice Address - Fax:814-941-3279
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-009587L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016376160002Medicaid
PA898456MG0Medicare PIN
PA0016376160002Medicaid