Provider Demographics
NPI:1619926193
Name:PATEL, RAJESH KACHARALAL (MD)
Entity Type:Individual
Prefix:
First Name:RAJESH
Middle Name:KACHARALAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1772 HOLLAND CT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3145
Mailing Address - Country:US
Mailing Address - Phone:407-804-6002
Mailing Address - Fax:407-804-8777
Practice Address - Street 1:1301 S INTERNATIONAL PARKWAY
Practice Address - Street 2:SUITE 1011
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1410
Practice Address - Country:US
Practice Address - Phone:407-804-6002
Practice Address - Fax:407-804-8777
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062618207K00000X, 207KA0200X, 207RA0201X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378852100Medicaid
F81976Medicare UPIN
FL27975YMedicare PIN