Provider Demographics
NPI:1194044388
Name:PATEL, PRADIP M (MD)
Entity Type:Individual
Prefix:DR
First Name:PRADIP
Middle Name:M
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:PO BOX 38
Mailing Address - Street 2:FEDERAL CORRECTIONAL INSTITUTION, HEALTH SERVICES DIV.
Mailing Address - City:FORT DIX
Mailing Address - State:NJ
Mailing Address - Zip Code:08640-0902
Mailing Address - Country:US
Mailing Address - Phone:609-723-1100
Mailing Address - Fax:
Practice Address - Street 1:5756 HARTFORD ROAD
Practice Address - Street 2:
Practice Address - City:FORT DIX
Practice Address - State:NJ
Practice Address - Zip Code:08640-0902
Practice Address - Country:US
Practice Address - Phone:609-723-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07004800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine