Provider Demographics
NPI:1447393483
Name:PATEL, SURYACHANDRA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SURYACHANDRA
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:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40146-0147
Mailing Address - Country:US
Mailing Address - Phone:270-547-7161
Mailing Address - Fax:270-547-7163
Practice Address - Street 1:205 WEST US 60
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:KY
Practice Address - Zip Code:40146
Practice Address - Country:US
Practice Address - Phone:270-547-7161
Practice Address - Fax:270-547-7163
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1049345OtherPASSPORT HEALTH PLAN
KYP00010531OtherRAILROAD MEDICARE
KY64209844Medicaid
KY000000047259OtherANTHEM BCBS
KY2432480000OtherPASSPORT ADVANTAGE
KYC74205Medicare UPIN
KYK178420Medicare PIN
KYP00010531OtherRAILROAD MEDICARE