Provider Demographics
NPI:1912943960
Name:PATIL, RAJASHRI (MD)
Entity Type:Individual
Prefix:
First Name:RAJASHRI
Middle Name:
Last Name:PATIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8210 WALNUT HILL LN
Mailing Address - Street 2:BLDG 1, STE 306
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4405
Mailing Address - Country:US
Mailing Address - Phone:214-306-4030
Mailing Address - Fax:214-242-6758
Practice Address - Street 1:8210 WALNUT HILL LN
Practice Address - Street 2:BLDG 1, STE 306
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4405
Practice Address - Country:US
Practice Address - Phone:214-306-4030
Practice Address - Fax:214-242-6758
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2746207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179061001Medicaid
TX179061002Medicaid
I47790Medicare UPIN
TX179061001Medicaid
TX613420Medicare PIN