Provider Demographics
NPI:1114983178
Name:PATEL, DAMYANTI S (MD)
Entity Type:Individual
Prefix:DR
First Name:DAMYANTI
Middle Name:S
Last Name:PATEL
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 1:1402 ESSEX GRN
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8349
Mailing Address - Country:US
Mailing Address - Phone:979-696-1231
Mailing Address - Fax:
Practice Address - Street 1:1201A BRIARCREST DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5223
Practice Address - Country:US
Practice Address - Phone:979-776-9400
Practice Address - Fax:979-774-8903
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6067208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAQ91OtherBLUE CROSS BLUE SHIELD
TXE27244Medicare UPIN
TXAQ91OtherBLUE CROSS BLUE SHIELD