Provider Demographics
NPI:1356456354
Name:PATEL, SANJIV M (MD)
Entity Type:Individual
Prefix:
First Name:SANJIV
Middle Name:M
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 1:168 KINSLEY ST
Mailing Address - Street 2:STE 4
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3634
Mailing Address - Country:US
Mailing Address - Phone:603-882-1501
Mailing Address - Fax:
Practice Address - Street 1:168 KINSLEY ST
Practice Address - Street 2:SUITE 4
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3634
Practice Address - Country:US
Practice Address - Phone:603-882-1501
Practice Address - Fax:603-882-9747
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8720207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHF33698OtherHARVARD PILGRIM
NH30005129Medicaid
NHRE2232Medicare ID - Type Unspecified
NHF33698Medicare UPIN