1225093990 NPI number — CHANDRAKANT M PATEL MD

Table of content: CHANDRAKANT M PATEL MD (NPI 1225093990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225093990 NPI number — CHANDRAKANT M PATEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
CHANDRAKANT
Provider Middle Name:
M
Provider Name Prefix Text:
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:
1225093990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4756 SOUTHMOOR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CHESTERFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23234-3748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-482-3646
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE # 2
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24541-2924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-799-2400
Provider Business Practice Location Address Fax Number:
434-793-0239
Provider Enumeration Date:
04/18/2006

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: 2084P0800X , with the licence number:  0101036870 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 049460 . This is a "ANTHEM BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 007100116 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 890544G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 802990 . This is a "OPTIMA" identifier . This identifiers is of the category "OTHER".