1629033949 NPI number — DR. VIJAY C PATEL M.D.

Table of content: DR. VIJAY C PATEL M.D. (NPI 1629033949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629033949 NPI number — DR. VIJAY C PATEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
VIJAY
Provider Middle Name:
C
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:
1629033949
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1038 MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01103-1120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-739-1100
Provider Business Mailing Address Fax Number:
413-735-1130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1038 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01103-2135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-739-1100
Provider Business Practice Location Address Fax Number:
413-735-1130
Provider Enumeration Date:
04/19/2006

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:  81270 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1310097 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3968488 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 19311 . This is a "HNE #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 743468 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9720719 . This is a "CIGNA #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: MP0365571AR . This is a "CSR #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000029989 . This is a "HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0034745 . This is a "NHP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04-08503 . This is a "EVERCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J16223 . This is a "BC/BS #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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