Provider Demographics
NPI:1174636716
Name:PATEL, TUSHAR G (MD)
Entity Type:Individual
Prefix:
First Name:TUSHAR
Middle Name:G
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 1:3914 CENTREVILLE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3289
Mailing Address - Country:US
Mailing Address - Phone:703-435-1223
Mailing Address - Fax:703-435-1868
Practice Address - Street 1:3914 CENTREVILLE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3289
Practice Address - Country:US
Practice Address - Phone:703-435-1223
Practice Address - Fax:703-435-1868
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0084773000Medicaid
017933000OtherBLACK LUNG
4660972OtherAETNA
VA006013198Medicaid
030090OtherANTHEM BCBS
VA00Y214T01Medicare PIN
030090OtherANTHEM BCBS
VA006013198Medicaid