MEDICARE: DR. RAJENDRA A PATEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	35039279	OH

General Provider Information

NPI Number	:	1134127954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJENDRA A PATEL MD

Provider Business Mailing Address
First Line	:	382 N DETROIT ST
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-2233
Country	:	US
Telephone Number	:	937-376-4460
Fax Number	:	937-376-3903

Provider Business Practice Location Address
First Line	:	382 N DETROIT ST
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-2233
Country	:	US
Telephone Number	:	937-376-4460
Fax Number	:	937-376-3903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	05/27/2008

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