Provider Demographics
NPI:1154324564
Name:PATEL, ASHWIN N (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHWIN
Middle Name:N
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-3023
Mailing Address - Country:US
Mailing Address - Phone:330-273-2656
Mailing Address - Fax:330-273-3755
Practice Address - Street 1:3801 CENTER RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-3023
Practice Address - Country:US
Practice Address - Phone:330-273-2656
Practice Address - Fax:330-273-3755
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHD98041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000120235OtherANTHEM
OH1600642OtherUHC
OH203740OtherBLACK LUNG
OHN379420OtherWELLCARE
OH0663447Medicaid
OHD98041Medicare UPIN
OH0663447Medicaid