Provider Demographics
NPI:1962471441
Name:JAITLY, RAKESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAKESH
Middle Name:
Last Name:JAITLY
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 1:640 S. STATE ST
Mailing Address - Street 2:MAIL CODE 3055
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3530
Mailing Address - Country:US
Mailing Address - Phone:302-480-1688
Mailing Address - Fax:302-480-9807
Practice Address - Street 1:200 BANNING ST STE 150
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3491
Practice Address - Country:US
Practice Address - Phone:302-744-6592
Practice Address - Fax:302-735-3240
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00463552084N0400X
DCMD209792084N0400X
DEC1-00266062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD751461100Medicaid
585117Medicare ID - Type Unspecified
MD751461100Medicaid