Provider Demographics
NPI:1063463784
Name:PATIDAR, SANDIP ARVIND (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDIP
Middle Name:ARVIND
Last Name:PATIDAR
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:PO BOX 1441
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105-1441
Mailing Address - Country:US
Mailing Address - Phone:866-972-9247
Mailing Address - Fax:509-586-5178
Practice Address - Street 1:900 S AUBURN STREET
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5621
Practice Address - Country:US
Practice Address - Phone:509-586-5945
Practice Address - Fax:509-586-5178
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000447962085R0202X
CAA840612085R0202X
CO505362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W0413OtherBCBS-TX
CA00A840610Medicaid
TX7660338OtherAETNA
TX155584903Medicaid
CO29527261Medicaid
WA8434086Medicaid
TXP00438460OtherMEDICARE RAILROAD
CO1063463784OtherBC/BS OF CO
TX8F4871Medicare PIN
CADT230XMedicare PIN
TXP00438460OtherMEDICARE RAILROAD
TX155584903Medicaid
WA84061AMedicare PIN
WA8434086Medicaid
CA00A840610Medicaid