Provider Demographics
NPI:1154386142
Name:PATEL, RAJENDRAKUMAR M (MD)
Entity type:Individual
Prefix:DR
First Name:RAJENDRAKUMAR
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAJENDRA
Other - Middle Name:M
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5 SALINA ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569
Mailing Address - Country:US
Mailing Address - Phone:585-786-3199
Mailing Address - Fax:585-786-3199
Practice Address - Street 1:5 SALINA ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569
Practice Address - Country:US
Practice Address - Phone:585-786-3199
Practice Address - Fax:585-786-3199
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151555207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00764750Medicaid
NY086671Medicare PIN
D75339Medicare UPIN