Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME118867 | FL |
Y | 111NI0900X | Internist | ME118867 | FL |
N | 2086S0120X | Pediatric Surgery | E-6028 | AR |
NPI | 1487819413 |
---|---|
Provider Name | Dr. Rahul Pathak |
First Address | Orlando, FL 32806-1110 |
Second Address | Orlando, FL 32806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2008 |
Last Update Date | 03/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012321000 | (05) | FL |