Provider Demographics
NPI:1396896023
Name:PATEL, RAJANKUMAR P (MD)
Entity type:Individual
Prefix:DR
First Name:RAJANKUMAR
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAJAN
Other - Middle Name:P
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1 BRITTANY BLVD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-5513
Mailing Address - Country:US
Mailing Address - Phone:856-983-8875
Mailing Address - Fax:
Practice Address - Street 1:1910 MARLTON PIKE E STE 6
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2123
Practice Address - Country:US
Practice Address - Phone:856-751-4831
Practice Address - Fax:856-751-2131
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71620207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH45873Medicare UPIN
NJ050224Medicare ID - Type Unspecified