Provider Demographics
NPI:1467443457
Name:P D PATEL MD PSC
Entity Type:Organization
Organization Name:P D PATEL MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PIYUSH
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-678-8323
Mailing Address - Street 1:104 HARDIN LN
Mailing Address - Street 2:SUITE#A
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3800
Mailing Address - Country:US
Mailing Address - Phone:606-678-8323
Mailing Address - Fax:606-451-0133
Practice Address - Street 1:104 HARDIN LN
Practice Address - Street 2:SUITE#A
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3800
Practice Address - Country:US
Practice Address - Phone:606-678-8323
Practice Address - Fax:606-451-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY200462084N0400X, 2084P0800X
KY363A00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6220Medicare ID - Type UnspecifiedMEDICARE GROUP#