Provider Demographics
NPI:1528037017
Name:RAKESH JAITLY MD PC
Entity Type:Organization
Organization Name:RAKESH JAITLY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAITLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-949-0607
Mailing Address - Street 1:10400 CONNECTICUT AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3910
Mailing Address - Country:US
Mailing Address - Phone:301-949-0607
Mailing Address - Fax:301-949-6603
Practice Address - Street 1:10400 CONNECTICUT AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-3910
Practice Address - Country:US
Practice Address - Phone:301-949-0607
Practice Address - Fax:301-949-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00463552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
585117Medicare ID - Type Unspecified