Provider Demographics
NPI:1013985936
Name:PATEL, RAJESH J (MD)
Entity Type:Individual
Prefix:
First Name:RAJESH
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:116 KERR AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740-1720
Mailing Address - Country:US
Mailing Address - Phone:570-398-1800
Mailing Address - Fax:570-398-3320
Practice Address - Street 1:116 KERR AVE
Practice Address - Street 2:SUITE B
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740-1720
Practice Address - Country:US
Practice Address - Phone:570-398-1800
Practice Address - Fax:570-398-3320
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD045497L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012630150001Medicaid
F02400Medicare UPIN
PA0012630150001Medicaid