Provider Demographics
NPI:1275766008
Name:SANTABA MEDICAL P.C.
Entity Type:Organization
Organization Name:SANTABA MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARAD
Authorized Official - Middle Name:KALIDAS
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-365-4364
Mailing Address - Street 1:3184 GRAND CONCOURSE
Mailing Address - Street 2:APT. #2F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458
Mailing Address - Country:US
Mailing Address - Phone:718-365-4364
Mailing Address - Fax:718-365-5817
Practice Address - Street 1:3184 GRAND CONCOURSE
Practice Address - Street 2:APT. #2F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458
Practice Address - Country:US
Practice Address - Phone:718-365-4364
Practice Address - Fax:718-365-5817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174974207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty