Provider Demographics
NPI:1104856905
Name:PATIL, LATA RAVINDRA (MD)
Entity Type:Individual
Prefix:MRS
First Name:LATA
Middle Name:RAVINDRA
Last Name:PATIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 PIERSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35042-2028
Mailing Address - Country:US
Mailing Address - Phone:205-926-3292
Mailing Address - Fax:
Practice Address - Street 1:208 PIERSON AVENUE
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:AL
Practice Address - Zip Code:35042
Practice Address - Country:US
Practice Address - Phone:205-926-4694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00011233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine