Provider Demographics
NPI:1437167657
Name:PATEL, HIMANSHU S (MD)
Entity Type:Individual
Prefix:DR
First Name:HIMANSHU
Middle Name:S
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 1:400 E BURWELL ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-4338
Mailing Address - Country:US
Mailing Address - Phone:540-387-3105
Mailing Address - Fax:540-387-3653
Practice Address - Street 1:400 E BURWELL ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-4338
Practice Address - Country:US
Practice Address - Phone:540-387-3105
Practice Address - Fax:540-387-3653
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010438832084P0804X, 2084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007111347Medicaid
003172OtherVALUE OPTIONS
395221OtherANTHEM, ANTHEM HEALTHKEEP
425443OtherMAMSI, MDIPA
460223000OtherMAGELLAN
089937OtherSENTARA/SOUTHERN HEALTH
4236878OtherAETNA
541925036OtherUBH/UHC
VARR260041904Medicare ID - Type UnspecifiedRAILROAD MEDICARE
395221OtherANTHEM, ANTHEM HEALTHKEEP
VA260002624Medicare ID - Type Unspecified