Provider Demographics
NPI:1245305440
Name:RADHARAJ, INC
Entity type:Organization
Organization Name:RADHARAJ, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHADRESH
Authorized Official - Middle Name:I
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-788-9086
Mailing Address - Street 1:802 DUNLAWTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127
Mailing Address - Country:US
Mailing Address - Phone:386-788-9086
Mailing Address - Fax:386-788-6589
Practice Address - Street 1:802 DUNLAWTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127
Practice Address - Country:US
Practice Address - Phone:386-788-9086
Practice Address - Fax:386-788-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0100873OtherUHC
FL5363010OtherAETNA
FL27612OtherBCBS
FL379467900Medicaid
FL6009354OtherGHI
FL5031818012OtherCIGNA
FL27612OtherBCBS
FL5363010OtherAETNA