MEDICARE: RAJESH V DALAL 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	207R00000X	Internal Medicine Physician	K0702	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316928021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJESH V DALAL MD

Provider Business Mailing Address
First Line	:	192 ABNER JACKSON PKWY
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5160
Country	:	US
Telephone Number	:	979-285-0007
Fax Number	:

Provider Business Practice Location Address
First Line	:	192 ABNER JACKSON PKWY
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5160
Country	:	US
Telephone Number	:	979-285-0007
Fax Number	:	979-256-0930

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/05/2021

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