MEDICARE: RAJ ASHOK 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	390200000X	Student in an Organized Health Care Education/Training Program	TRN27315	FL
2	390200000X	Student in an Organized Health Care Education/Training Program		CT
3	2085R0204X	Vascular & Interventional Radiology Physician	2024-01151	NC
4	2085R0202X	Diagnostic Radiology Physician	2024-01151	NC

General Provider Information

NPI Number	:	1114412475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJ ASHOK PATEL MD

Provider Business Mailing Address
First Line	:	1176 E CUTLAR XING STE 200
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-6426
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1176 E CUTLAR XING STE 200
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-6426
Country	:	US
Telephone Number	:	703-783-5353
Fax Number	:

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

Provider Enumeration Date	:	06/28/2018
Last Update Date	:	06/03/2024

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