1750378840 NPI number — DR. CHANDRAKANT PATEL M.D.

Table of content: DR. CHANDRAKANT PATEL M.D. (NPI 1750378840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750378840 NPI number — DR. CHANDRAKANT PATEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
CHANDRAKANT
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750378840
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 SUTTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH ANDOVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01845-1640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-687-2321
Provider Business Mailing Address Fax Number:
978-685-7265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 SUTTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH ANDOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01845-1640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-687-2321
Provider Business Practice Location Address Fax Number:
978-685-7265
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  37685 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208100000X , with the licence number: 5978 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0013753 . This is a "NHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4373130 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 00000142 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1249360-001 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2066599 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23-00142 . This is a "EVERCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 26773 . This is a "FCHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: B54044 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 702707 . This is a "THP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0102642Y0MA01 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 23-00012 . This is a "UHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 80287 . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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