Healthcare Provider Details

I. General information

NPI: 1063434314
Provider Name (Legal Business Name): RAJIV ARVIND PATEL MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 03/20/2021
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 DANVILLE DR
PRINCETON JUNCTION NJ
08550-0000
US

IV. Provider business mailing address

1 W ELM ST STE 100
CONSHOHOCKEN PA
19428-4108
US

V. Phone/Fax

Practice location:
  • Phone: 609-751-2332
  • Fax:
Mailing address:
  • Phone: 609-751-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME93131
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA08374000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number248416
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD07854L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2008-01034
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101257461
License Number StateVA
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2008-01034
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: