Provider Demographics
NPI:1619020989
Name:RAJESH B.DAVE,MD,PA
Entity Type:Organization
Organization Name:RAJESH B.DAVE,MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-848-0247
Mailing Address - Street 1:6424 EMBASSY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-4980
Mailing Address - Country:US
Mailing Address - Phone:727-848-0247
Mailing Address - Fax:727-841-6351
Practice Address - Street 1:6424 EMBASSY BLVD STE A
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4980
Practice Address - Country:US
Practice Address - Phone:727-848-0247
Practice Address - Fax:727-841-6351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256173500Medicaid
FL371899900Medicaid
FLK0301Medicare ID - Type Unspecified