Provider Demographics
NPI:1235217720
Name:PATEL, PURVI R (MD)
Entity Type:Individual
Prefix:
First Name:PURVI
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 N SAN FERNANDO BLVD
Mailing Address - Street 2:STE J 237
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4350
Mailing Address - Country:US
Mailing Address - Phone:408-439-1012
Mailing Address - Fax:
Practice Address - Street 1:928 N SAN FERNANDO BLVD
Practice Address - Street 2:STE J 237
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-4350
Practice Address - Country:US
Practice Address - Phone:408-439-1012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82356207RH0002X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H92691Medicare UPIN
00A823560Medicare ID - Type Unspecified