Provider Demographics
NPI:1144214925
Name:PATEL, RAJESH G (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:G
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 1:1860 CHADWICK DR
Mailing Address - Street 2:STE 105
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3465
Mailing Address - Country:US
Mailing Address - Phone:601-376-2982
Mailing Address - Fax:601-376-2981
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:SUITE 480
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2001
Practice Address - Country:US
Practice Address - Phone:601-352-2273
Practice Address - Fax:601-714-3415
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13294174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121687Medicaid
MS290000075Medicare ID - Type Unspecified
MS302I297167Medicare PIN
MSH12783Medicare UPIN