Healthcare Provider Details

I. General information

NPI: 1669785572
Provider Name (Legal Business Name): RAJESH C. PATEL, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7056 CORPORATE WAY
CENTERVILLE OH
45459-4274
US

IV. Provider business mailing address

7056 CORPORATE WAY
CENTERVILLE OH
45459-4274
US

V. Phone/Fax

Practice location:
  • Phone: 937-312-9144
  • Fax: 937-312-9146
Mailing address:
  • Phone: 937-312-9144
  • Fax: 937-312-9146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number11185
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOH35-07-1174
License Number StateOH

VIII. Authorized Official

Name: DR. THOMAS M. YUNGER JR.
Title or Position: DIRECTOR
Credential: M.D.
Phone: 937-312-9144