Provider Demographics
NPI:1215593082
Name:PATEL, KHUSBUBEN SHANTILAL (MD)
Entity Type:Individual
Prefix:
First Name:KHUSBUBEN
Middle Name:SHANTILAL
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KHUSBUBEN
Other - Middle Name:S
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4124 CHESAPEAKE SQUARE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321
Mailing Address - Country:US
Mailing Address - Phone:757-983-5100
Mailing Address - Fax:757-673-8292
Practice Address - Street 1:4124 CHESAPEAKE SQUARE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2134
Practice Address - Country:US
Practice Address - Phone:757-983-5100
Practice Address - Fax:757-673-8292
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101276311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program