Provider Demographics
NPI:1093158628
Name:PATEL, KAMAL BHARAT (DO)
Entity Type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:BHARAT
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
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 69
Mailing Address - Street 2:3622 ROUTE 343
Mailing Address - City:AMENIA
Mailing Address - State:NY
Mailing Address - Zip Code:12501-0069
Mailing Address - Country:US
Mailing Address - Phone:607-592-7053
Mailing Address - Fax:
Practice Address - Street 1:200 SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1198
Practice Address - Country:US
Practice Address - Phone:781-687-2241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-13
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09947700207Q00000X, 207QS0010X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program