Provider Demographics
NPI:1225052897
Name:PATEL, SHOBHA R (MD)
Entity Type:Individual
Prefix:DR
First Name:SHOBHA
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2340
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11969-2340
Mailing Address - Country:US
Mailing Address - Phone:631-283-2430
Mailing Address - Fax:631-283-7496
Practice Address - Street 1:325 MEETING HOUSE LN
Practice Address - Street 2:BUILDING #2
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5087
Practice Address - Country:US
Practice Address - Phone:631-283-4048
Practice Address - Fax:631-283-5396
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203693207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01837663Medicaid
NY2592199OtherGHI
NY200309210OtherCOMMERCIAL
NY2539648OtherCIGNA HEALTHCARE
NY161AD1OtherEMPIRE BLUE CROSS BLUE SH
NY01837663Medicaid
NY200309210OtherCOMMERCIAL
NYWGC601Medicare PIN