Provider Demographics
NPI:1316018831
Name:PATEL, MAHENDRA S (MD)
Entity Type:Individual
Prefix:
First Name:MAHENDRA
Middle Name:S
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:270 SMITH CHURCH ROAD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4914
Mailing Address - Country:US
Mailing Address - Phone:252-537-0134
Mailing Address - Fax:252-537-6515
Practice Address - Street 1:270 SMITH CHURCH ROAD
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4914
Practice Address - Country:US
Practice Address - Phone:252-537-0134
Practice Address - Fax:252-537-6515
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC27500207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC028182OtherVABCBS
18619OtherCAPITOL BC PENN
830000763OtherRAILROAD MEDICARE PALMETT
72540OtherMEDCOST
020384900OtherDIVISION OF COAL MINERS
NC65957OtherBCBSNC
1435956HALIOtherUNITED MINE WORKERS
3655340OtherUNITED HEALTHCARE
6051669OtherVIRGINIA MEDICAID
NC8965957Medicaid
18619OtherCAPITOL BC PENN
6051669OtherVIRGINIA MEDICAID