1861424285 NPI number — DR. PRAVIN I PATEL MD

Table of content: DR. PRAVIN I PATEL MD (NPI 1861424285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861424285 NPI number — DR. PRAVIN I PATEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
PRAVIN
Provider Middle Name:
I
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1861424285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1322 LOCUST AVE
Provider Second Line Business Mailing Address:
PO BOX 1112
Provider Business Mailing Address City Name:
FAIRMONT
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-366-0700
Provider Business Mailing Address Fax Number:
304-366-9529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1322 LOCUST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRMONT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-366-0700
Provider Business Practice Location Address Fax Number:
304-366-9529
Provider Enumeration Date:
07/07/2006

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: 207R00000X , with the licence number:  10239 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110087720 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 505819 . This is a "NATIONAL CAPITAL PPO" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 000058954 . This is a "MT STATE BC/BS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0082810000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0004420446 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: FQ10239 . This is a "HEALTH PLAN" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0573008 . This is a "HOME PLAN PEIA AND CHIPS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: E19547 . This is a "WV WORKER'S COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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