Provider Demographics
NPI:1245209402
Name:PATEL, HARESH J (MD)
Entity Type:Individual
Prefix:DR
First Name:HARESH
Middle Name:J
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 1:1520 SLATE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-6975
Mailing Address - Country:US
Mailing Address - Phone:276-935-2148
Mailing Address - Fax:276-935-7270
Practice Address - Street 1:1520 SLATE CREEK RD
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614-6975
Practice Address - Country:US
Practice Address - Phone:276-935-2148
Practice Address - Fax:276-935-7220
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053462207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64028335Medicaid
VI7934282OtherAETNA
VA005853214Medicaid
VA453692OtherANTHEM BCBS OF VIRGINIA
WV1804504000Medicaid
VA295535900OtherFEDERAL BLACK LUNG
WV1804504000Medicaid
VA110007998Medicare ID - Type Unspecified
VA005853214Medicaid