Provider Demographics
NPI:1225022965
Name:PATEL, RAJESH C (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:C
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 1:9001 N MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1175
Mailing Address - Country:US
Mailing Address - Phone:937-832-0990
Mailing Address - Fax:937-832-7323
Practice Address - Street 1:9001 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1175
Practice Address - Country:US
Practice Address - Phone:937-832-0990
Practice Address - Fax:937-832-7323
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-7793P174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1225022965OtherNPI NUMBER
OH0753626Medicaid
OHD70419Medicare UPIN
OHPA0642242Medicare ID - Type Unspecified