1902825441 NPI number — DR. ASHOK JIVANLAL PATEL M.D.

Table of content: BENJAMIN WALKER FISCHER-VALUCK MD (NPI 1023351673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902825441 NPI number — DR. ASHOK JIVANLAL PATEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
ASHOK
Provider Middle Name:
JIVANLAL
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:
1902825441
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 DORCHESTER AVE
Provider Second Line Business Mailing Address:
SETON MEDICAL BUILDING-SUITE 303
Provider Business Mailing Address City Name:
DORCHESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-296-0720
Provider Business Mailing Address Fax Number:
617-296-5166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2110 DORCHESTER AVE
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
DORCHESTER CENTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02124-5628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-296-0720
Provider Business Practice Location Address Fax Number:
617-296-5166
Provider Enumeration Date:
07/18/2006

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: 207RA0000X , with the licence number:  52194 , 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: 04-05063 . This is a "EVERCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0030542 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4488345 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 030506866 . This is a "CIGNA AARP COMMONWLTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3127303 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00057680 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 052194 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 64369 . This is a "HARVARD PILGRIM HLTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J30545 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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