Provider Demographics
NPI:1861692626
Name:REKHA M JAIN M.D.
Entity type:Organization
Organization Name:REKHA M JAIN M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REKHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-878-8620
Mailing Address - Street 1:2411 E MILLBROOK RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-2800
Mailing Address - Country:US
Mailing Address - Phone:919-878-8620
Mailing Address - Fax:919-790-0012
Practice Address - Street 1:2411 E MILLBROOK RD
Practice Address - Street 2:SUITE 111
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-2800
Practice Address - Country:US
Practice Address - Phone:919-878-8620
Practice Address - Fax:919-790-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8945702Medicaid
NCC-81537Medicare UPIN
NC8945702Medicaid