Provider Demographics
NPI:1023053402
Name:RAI-PATEL, JITHA (MD)
Entity type:Individual
Prefix:MS
First Name:JITHA
Middle Name:
Last Name:RAI-PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:609-265-1700
Mailing Address - Fax:609-265-8146
Practice Address - Street 1:693 MAIN ST BUILDING A STE 2
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-5043
Practice Address - Country:US
Practice Address - Phone:609-265-1700
Practice Address - Fax:609-265-8146
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24MA09629800174400000X
174400000X
PAMD428142207R00000X, 207RG0100X
NJ25MA09629800207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0496626Medicaid
PA232359401OtherMAIN LINE HEALTHCARE
PA1018468980002Medicaid
PA102481N2PMedicare ID - Type Unspecified
PA232359401OtherMAIN LINE HEALTHCARE
I56194Medicare UPIN
NJ0496626Medicaid
NJ404151BDEMedicare PIN