Provider Demographics
NPI:1144384777
Name:PATEL, SURESH AMBALAL (MD)
Entity Type:Individual
Prefix:MR
First Name:SURESH
Middle Name:AMBALAL
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 1:323 MARION AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3639
Mailing Address - Country:US
Mailing Address - Phone:330-493-3313
Mailing Address - Fax:330-493-6413
Practice Address - Street 1:323 MARION AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3639
Practice Address - Country:US
Practice Address - Phone:330-493-3313
Practice Address - Fax:330-493-6413
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047644P2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0505493Medicaid
OHPA0515602Medicare ID - Type Unspecified
OH0505493Medicaid