Provider Demographics
NPI:1326055609
Name:PATEL, PRAVINCHANDRA H (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAVINCHANDRA
Middle Name:H
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 1:1041 TALBOTTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8745
Mailing Address - Country:US
Mailing Address - Phone:706-327-0700
Mailing Address - Fax:706-327-0757
Practice Address - Street 1:1130 TALBOTTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8749
Practice Address - Country:US
Practice Address - Phone:706-327-0700
Practice Address - Fax:706-327-0757
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027888207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E00848Medicare UPIN
GA10BBBQXMedicare ID - Type Unspecified