Provider Demographics
NPI:1467449595
Name:PATEL, MEHUL PRAVINBHAI (MD FACC)
Entity Type:Individual
Prefix:
First Name:MEHUL
Middle Name:PRAVINBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:243 NORTH RD STE 304
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1173
Mailing Address - Country:US
Mailing Address - Phone:884-451-7251
Mailing Address - Fax:845-471-7372
Practice Address - Street 1:5 JEANNE DR
Practice Address - Street 2:SUITE 7
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1702
Practice Address - Country:US
Practice Address - Phone:845-565-4400
Practice Address - Fax:845-565-4822
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY228210207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02425212Medicaid
MP0526P810Medicare ID - Type Unspecified
NY02425212Medicaid