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

Table of content: DR. ASHOK JIVANLAL PATEL M.D. (NPI 1902825441)

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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