Provider Demographics
NPI:1235129404
Name:PATEL, JAGDISH HARIPRASAD (MD)
Entity Type:Individual
Prefix:
First Name:JAGDISH
Middle Name:HARIPRASAD
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 1:1455 PARKMAN RD NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-2156
Mailing Address - Country:US
Mailing Address - Phone:330-394-3816
Mailing Address - Fax:330-399-7295
Practice Address - Street 1:1296 TOD PL NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-2474
Practice Address - Country:US
Practice Address - Phone:330-841-1001
Practice Address - Fax:330-841-4644
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH42368207Q00000X
OH35.042368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0365019Medicaid
OHPA0451441Medicare ID - Type Unspecified
OH0365019Medicaid