Provider Demographics
NPI:1134127954
Name:PATEL, RAJENDRA A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJENDRA
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2233
Mailing Address - Country:US
Mailing Address - Phone:937-376-4460
Mailing Address - Fax:937-376-3903
Practice Address - Street 1:382 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2233
Practice Address - Country:US
Practice Address - Phone:937-376-4460
Practice Address - Fax:937-376-3903
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039279207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD32011Medicare UPIN