Provider Demographics
NPI: | 1376587352 |
---|---|
Name: | PATEL, SAURABH (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | SAURABH |
Middle Name: | |
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: | 2125 OAK GROVE RD |
Mailing Address - Street 2: | SUITE 200 |
Mailing Address - City: | WALNUT CREEK |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94598-2536 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 925-296-7150 |
Mailing Address - Fax: | 925-296-7171 |
Practice Address - Street 1: | 2125 OAK GROVE RD |
Practice Address - Street 2: | SUITE 200 |
Practice Address - City: | WALNUT CREEK |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94598-2536 |
Practice Address - Country: | US |
Practice Address - Phone: | 925-296-7150 |
Practice Address - Fax: | 925-296-7171 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-16 |
Last Update Date: | 2015-04-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | A70005 | 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 00A700051 | Medicare ID - Type Unspecified | |
CA | H82605 | Medicare UPIN | |
CA | 00A700053 | Medicare ID - Type Unspecified | |
CA | 00A700052 | Medicare ID - Type Unspecified |