Provider Demographics
NPI:1225093990
Name:PATEL, CHANDRAKANT M (MD)
Entity Type:Individual
Prefix:
First Name:CHANDRAKANT
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 1:4756 SOUTHMOOR RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-3748
Mailing Address - Country:US
Mailing Address - Phone:804-482-3646
Mailing Address - Fax:
Practice Address - Street 1:212 S MAIN ST
Practice Address - Street 2:SUITE # 2
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2924
Practice Address - Country:US
Practice Address - Phone:434-799-2400
Practice Address - Fax:434-793-0239
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010368702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890544GMedicaid
802990OtherOPTIMA
VA007100116Medicaid
049460OtherANTHEM BC/BS