1376831990 NPI number — DR. CHIRAG K PATEL O.D

Table of content: DR. CHIRAG K PATEL O.D (NPI 1376831990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376831990 NPI number — DR. CHIRAG K PATEL O.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
CHIRAG
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.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:
1376831990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
464 HILLSIDE AVE
Provider Second Line Business Mailing Address:
SUITE #205
Provider Business Mailing Address City Name:
NEEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02494-1227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-726-7337
Provider Business Mailing Address Fax Number:
781-726-7310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
464 HILLSIDE AVE
Provider Second Line Business Practice Location Address:
SUITE #205
Provider Business Practice Location Address City Name:
NEEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02494-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-726-7337
Provider Business Practice Location Address Fax Number:
781-726-7310
Provider Enumeration Date:
07/17/2011

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: 152W00000X , with the licence number:  7826TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 5011 , 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: 112409104 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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