Provider Demographics
NPI:1275531162
Name:GAJERA, RATILAL G (MD)
Entity Type:Individual
Prefix:MR
First Name:RATILAL
Middle Name:G
Last Name:GAJERA
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 1:1717 HIGH ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-6300
Mailing Address - Country:US
Mailing Address - Phone:270-885-0570
Mailing Address - Fax:270-885-0573
Practice Address - Street 1:1717 HIGH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-6300
Practice Address - Country:US
Practice Address - Phone:270-885-0570
Practice Address - Fax:270-885-0573
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22180207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65941031Medicaid
KY64221807Medicaid
KY000000315811OtherANTHEM
KY0796101Medicare PIN
KYP00076948Medicare ID - Type UnspecifiedMEDICARE RAILROAD
KY65941031Medicaid
KY000000315811OtherANTHEM
KY64221807Medicaid