Provider Demographics
NPI:1063434314
Name:PATEL, RAJIV ARVIND (MD PHD)
Entity type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:ARVIND
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:STE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4108
Mailing Address - Country:US
Mailing Address - Phone:609-751-2332
Mailing Address - Fax:
Practice Address - Street 1:73 DANVILLE DR
Practice Address - Street 2:
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-0000
Practice Address - Country:US
Practice Address - Phone:609-751-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93131174400000X
NJ25MA08374000174400000X
NY248416207R00000X
PAMD07854L207RC0000X
NC2008-01034208M00000X, 207R00000X
VA0101257461208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLREF804494Medicaid
FLREF804494Medicaid
FLAC840ZMedicare PIN