Provider Demographics
NPI:1083758635
Name:PATEL, ASHISH B (MD)
Entity Type:Individual
Prefix:
First Name:ASHISH
Middle Name:B
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 PIEDMONT AVE NE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3307
Mailing Address - Country:US
Mailing Address - Phone:609-721-1130
Mailing Address - Fax:
Practice Address - Street 1:2675 N DECATUR RD STE G09
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6130
Practice Address - Country:US
Practice Address - Phone:404-501-6925
Practice Address - Fax:404-501-6930
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA842532085R0001X, 2085R0001X
PAMD4367812085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00749435OtherRAILROAD MEDICARE
PA102332970Medicaid
PA162723Medicare PIN