1114185071 NPI number — ZALAK RAMANLAL PATEL MBBS MD

Table of content: ZALAK RAMANLAL PATEL MBBS MD (NPI 1114185071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114185071 NPI number — ZALAK RAMANLAL PATEL MBBS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
ZALAK
Provider Middle Name:
RAMANLAL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MBBS MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PATEL
Provider Other First Name:
ZALAK
Provider Other Middle Name:
RAMAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MBBS MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1114185071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 ARCHARD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30809-7058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-608-8389
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 15TH ST
Provider Second Line Business Practice Location Address:
BI 2144
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30912-0004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-608-8389
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2008

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: 207L00000X , with the licence number:  70397 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112363800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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