Provider Demographics
NPI:1235199175
Name:PATEL, SURESH M (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SURESHCHANDRA
Other - Middle Name:M
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:576 GOLF CLUB RD
Mailing Address - Street 2:APT 5
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-5292
Mailing Address - Country:US
Mailing Address - Phone:434-724-2433
Mailing Address - Fax:
Practice Address - Street 1:382 TAYLOR DR
Practice Address - Street 2:SOUTHERN VIRGINIA MENTAL HEALTH INSTITUTE
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4023
Practice Address - Country:US
Practice Address - Phone:434-799-6220
Practice Address - Fax:434-773-4241
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010296982084P0800X
NY1389612084P0800X
PAMD026206E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E16805Medicare UPIN