Provider Demographics
NPI:1740362490
Name:PATEL, RAJAN PRAVIN (MD)
Entity type:Individual
Prefix:
First Name:RAJAN
Middle Name:PRAVIN
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1098 FOSTER CITY BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2375
Mailing Address - Country:US
Mailing Address - Phone:650-474-2130
Mailing Address - Fax:833-499-1785
Practice Address - Street 1:5050 EL CAMINO REAL
Practice Address - Street 2:#110
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022
Practice Address - Country:US
Practice Address - Phone:650-964-6700
Practice Address - Fax:650-964-3495
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2021-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG71817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E93703Medicare UPIN
00G718170Medicare ID - Type Unspecified