Provider Demographics
NPI:1619074861
Name:RAJESH DHAIRYAWAN MD PA
Entity Type:Organization
Organization Name:RAJESH DHAIRYAWAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:DHAIRYAWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-412-0998
Mailing Address - Street 1:9900 SW 107TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2798
Mailing Address - Country:US
Mailing Address - Phone:305-412-0998
Mailing Address - Fax:305-412-2790
Practice Address - Street 1:9900 SW 107TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2798
Practice Address - Country:US
Practice Address - Phone:305-412-0998
Practice Address - Fax:305-412-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254742200Medicaid
FL023962100Medicaid
FL254742200Medicaid