Provider Demographics
NPI:1225355720
Name:PATIL, AMOL (MD, MBBS)
Entity Type:Individual
Prefix:
First Name:AMOL
Middle Name:
Last Name:PATIL
Suffix:
Gender:M
Credentials:MD, MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 BATH ST
Mailing Address - Street 2:113
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4339
Mailing Address - Country:US
Mailing Address - Phone:805-560-8111
Mailing Address - Fax:
Practice Address - Street 1:2320 BATH ST
Practice Address - Street 2:113
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4339
Practice Address - Country:US
Practice Address - Phone:805-560-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1339732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB260149Medicare PIN
CACB256694Medicare PIN