Provider Demographics
NPI:1417998444
Name:PATEL, BHARATBHAI G
Entity Type:Individual
Prefix:
First Name:BHARATBHAI
Middle Name:G
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4127
Mailing Address - Street 2:BHARATBHAI G PATEL MD
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015
Mailing Address - Country:US
Mailing Address - Phone:540-981-9394
Mailing Address - Fax:540-344-7154
Practice Address - Street 1:5712 LONG RIDGE RD
Practice Address - Street 2:BHARATBHAI G PATEL MD
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-344-9779
Practice Address - Fax:540-725-5876
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110206915OtherMCRR
119503OtherANTHEM
VA005836158Medicaid
119503OtherANTHEM
VA005836158Medicaid