Provider Demographics
NPI:1932112026
Name:PATEL, RAJESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:
Last Name:PATEL
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 1:10051 5TH STREET NORTH
Mailing Address - Street 2:#200
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702
Mailing Address - Country:US
Mailing Address - Phone:941-757-2100
Mailing Address - Fax:941-757-2101
Practice Address - Street 1:5534 CORTEZ ROAD WEST
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2817
Practice Address - Country:US
Practice Address - Phone:941-757-2100
Practice Address - Fax:941-757-2101
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118888207Q00000X
PAMD429796207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1886706OtherHIGHMARK BLUE SHIELD
PA205723OtherJOHNS HOPKINS
PA7116850OtherAETNA
PA101705049Medicaid
PAP00376682Medicare PIN
PA103026OtherGEISINGER
MD889332OtherCAREFIRST MD BCBS
PA106657FLTMedicare PIN
I67575Medicare UPIN