Provider Demographics
NPI:1407862378
Name:PATEL, ASHOKKUMAR BALUBHAI (MD)
Entity Type:Individual
Prefix:
First Name:ASHOKKUMAR
Middle Name:BALUBHAI
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 1:1 COVINGTON LANE
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4132
Mailing Address - Country:US
Mailing Address - Phone:856-751-8634
Mailing Address - Fax:856-751-2353
Practice Address - Street 1:2827 WESTFIELD AVE.
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08105
Practice Address - Country:US
Practice Address - Phone:856-964-6400
Practice Address - Fax:856-964-2255
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04405700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0208302Medicaid
NJ0208302Medicaid
D91225Medicare UPIN