Provider Demographics
NPI:1417047945
Name:GOYAL, RAJIVA (MD)
Entity type:Individual
Prefix:DR
First Name:RAJIVA
Middle Name:
Last Name:GOYAL
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 1:14100 FIVAY RD STE 120
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7159
Mailing Address - Country:US
Mailing Address - Phone:727-819-2338
Mailing Address - Fax:727-819-2481
Practice Address - Street 1:14100 FIVAY RD STE 120
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7159
Practice Address - Country:US
Practice Address - Phone:727-819-2338
Practice Address - Fax:727-819-2481
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06211ZMedicare ID - Type Unspecified
FLG13792Medicare UPIN