Provider Demographics
NPI:1902899099
Name:PATEL, RAJIV R (MD)
Entity Type:Individual
Prefix:
First Name:RAJIV
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 W MAIN ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2170
Mailing Address - Country:US
Mailing Address - Phone:937-383-1588
Mailing Address - Fax:937-383-4525
Practice Address - Street 1:630 W MAIN ST
Practice Address - Street 2:SUITE 307
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2170
Practice Address - Country:US
Practice Address - Phone:937-383-1588
Practice Address - Fax:937-383-4525
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHMD062974L/PA207V00000X
OH35-076617207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2142612Medicaid
OH4011331Medicare PIN