Provider Demographics
NPI:1124072699
Name:RAJ KHAMBHATI MD PA
Entity type:Organization
Organization Name:RAJ KHAMBHATI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMBHATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-642-0307
Mailing Address - Street 1:2135 S CONGRESS AVE
Mailing Address - Street 2:SUITE #3A
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406
Mailing Address - Country:US
Mailing Address - Phone:561-642-0307
Mailing Address - Fax:561-642-7128
Practice Address - Street 1:2135 SOUTH CONGRESS AVENUE
Practice Address - Street 2:SUITE #3A
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406
Practice Address - Country:US
Practice Address - Phone:561-642-0307
Practice Address - Fax:561-642-7128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 48202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD84643Medicare UPIN
FL02737Medicare PIN