Provider Demographics
NPI:1972626992
Name:PATEL, RAJENDRA (MD)
Entity Type:Individual
Prefix:
First Name:RAJENDRA
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 1:77 W UNDERWOOD ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1122
Mailing Address - Country:US
Mailing Address - Phone:321-841-3200
Mailing Address - Fax:321-843-6744
Practice Address - Street 1:77 W UNDERWOOD ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1122
Practice Address - Country:US
Practice Address - Phone:321-841-3200
Practice Address - Fax:321-843-6744
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2309852086S0129X
FLME1042292086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBZ737ZMedicare PIN
FLBZ737YMedicare PIN