1154593168 NPI number — MR. DEEP VINU PATEL MD

Table of content: MR. DEEP VINU PATEL MD (NPI 1154593168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154593168 NPI number — MR. DEEP VINU PATEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
DEEP
Provider Middle Name:
VINU
Provider Name Prefix Text:
MR.
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:
1154593168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1603 SANTA ROSA RD
Provider Second Line Business Mailing Address:
RM 102
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23229-5010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-288-6750
Provider Business Mailing Address Fax Number:
804-288-6753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7605 FOREST AVE
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23229-4938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-285-6390
Provider Business Practice Location Address Fax Number:
804-285-6393
Provider Enumeration Date:
03/31/2008

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: 207RN0300X , with the licence number:  0101249866 , 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: VV3694B . This is a "MEDICARE PROVIDER PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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