Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD428142 | PA |
N | 111NI0900X | Internist | MD428142 | PA |
Y | 207RG0100X | Gastroenterologist | 25MA09629800 | NJ |
N | 207RG0100X | Gastroenterologist | MD428142 | PA |
NPI | 1023053402 |
---|---|
Provider Name | Ms. Jitha Rai-Patel |
First Address | Lumberton, NJ 08048 |
Second Address | Lumberton, NJ 08048-5043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0496626 | (05) | NJ |
1018468980002 | (05) | PA |
232359401 | MAIN LINE HEALTHCARE (01) | PA |
I56194 | (02) |