Provider Demographics
NPI:1316928021
Name:DALAL, RAJESH V (MD)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:V
Last Name:DALAL
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 1:192 ABNER JACKSON PKWY
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5160
Mailing Address - Country:US
Mailing Address - Phone:979-285-0007
Mailing Address - Fax:
Practice Address - Street 1:192 ABNER JACKSON PKWY
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5160
Practice Address - Country:US
Practice Address - Phone:979-285-0007
Practice Address - Fax:979-256-0930
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT4119Medicaid
TX00U02TMedicare PIN
TXT4119Medicaid