Provider Demographics
NPI:1417149253
Name:PATEL, AMITA N (MD)
Entity Type:Individual
Prefix:DR
First Name:AMITA
Middle Name:N
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 S COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-7219
Mailing Address - Country:US
Mailing Address - Phone:662-334-6448
Mailing Address - Fax:662-334-6461
Practice Address - Street 1:1502 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-7219
Practice Address - Country:US
Practice Address - Phone:662-334-6448
Practice Address - Fax:662-334-6461
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14324207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121838Medicaid
AR133861001Medicaid
AR53529OtherBLUE CROSS BLUE SHIELD
AR5M681Medicare PIN
MS00121838Medicaid
AR133861001Medicaid