Provider Demographics
NPI:1114627650
Name:PATEL, KUSH GHANSHYAM
Entity Type:Individual
Prefix:MR
First Name:KUSH
Middle Name:GHANSHYAM
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1802
Mailing Address - Country:US
Mailing Address - Phone:475-355-0962
Mailing Address - Fax:
Practice Address - Street 1:145 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1802
Practice Address - Country:US
Practice Address - Phone:475-355-0962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program