Provider Demographics
NPI:1346265097
Name:PATEL, NIRANJAN SHASHIKANT (MD)
Entity Type:Individual
Prefix:MR
First Name:NIRANJAN
Middle Name:SHASHIKANT
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 1:5200 RAPHAEL DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2464
Mailing Address - Country:US
Mailing Address - Phone:318-473-0544
Mailing Address - Fax:318-473-0577
Practice Address - Street 1:3113 HIGHWAY 28 E
Practice Address - Street 2:PINEVILLE MEDICAL CENTER
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5783
Practice Address - Country:US
Practice Address - Phone:318-767-2222
Practice Address - Fax:318-767-2264
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD05137R208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1357588Medicaid
LA1357588Medicaid
LA51101Medicare ID - Type Unspecified