Provider Demographics
NPI:1003876657
Name:PATADIA, BIPIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:BIPIN
Middle Name:C
Last Name:PATADIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 N 13TH AVE
Mailing Address - Street 2:# D
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-946-5851
Mailing Address - Fax:909-931-9437
Practice Address - Street 1:630 N 13TH AVE
Practice Address - Street 2:# D
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-946-5851
Practice Address - Fax:909-931-9437
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31085174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A26344Medicare UPIN