Provider Demographics
NPI:1316187263
Name:PATEL, TEJAS NAVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:TEJAS
Middle Name:NAVIN
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TEJAS
Other - Middle Name:NAVINCHANDRA
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-7237
Mailing Address - Fax:215-707-9389
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-7237
Practice Address - Fax:215-707-9389
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4502092085R0202X
AZ461232085R0202X, 2085B0100X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ005472OtherGROUP MEDICAID ID
AZ706543Medicaid
AZZWCBBMOtherGROUP MEDICARE ID
AZCS7943OtherGROUP MEDICARE RAILROAD ID & PTAN
AZP01080312OtherMEDICARE RAILROAD
AZ1841261989OtherGROUP NPI
AZ1316187263OtherPHYSICIAN INDIVIDUAL NPI
AZ005472OtherGROUP MEDICAID ID
AZ1316187263OtherPHYSICIAN INDIVIDUAL NPI