Provider Demographics
NPI:1346200599
Name:PATEL, KIRAN R (MD)
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:R
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 1:108 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1666
Mailing Address - Country:US
Mailing Address - Phone:304-344-0850
Mailing Address - Fax:304-766-4337
Practice Address - Street 1:401 DIVISION ST
Practice Address - Street 2:STE 306
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1455
Practice Address - Country:US
Practice Address - Phone:304-766-4300
Practice Address - Fax:304-766-4337
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV17053207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0092257000Medicaid
WV0092257000Medicaid
WVF32982Medicare UPIN