MEDICARE: RAJESWARA R. PATCHA 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	207RC0000X	Cardiovascular Disease Physician	147275	NY
2	207RI0011X	Interventional Cardiology Physician	147275	NY

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	:	1104829407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJESWARA R. PATCHA MD

Provider Business Mailing Address
First Line	:	172 E MAIN ST
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-2948
Country	:	US
Telephone Number	:	631-385-0022
Fax Number	:	631-385-0896

Provider Business Practice Location Address
First Line	:	172 E MAIN ST
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-2948
Country	:	US
Telephone Number	:	631-385-0022
Fax Number	:	631-385-0896

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	03/19/2020

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