Provider Demographics
NPI:1467510990
Name:PATEL, VASISHTA M (MD)
Entity Type:Individual
Prefix:DR
First Name:VASISHTA
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3139 W HOLCOMBE BLVD, BOX 574
Mailing Address - Street 2:BOX 574
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-4263
Mailing Address - Country:US
Mailing Address - Phone:281-540-0053
Mailing Address - Fax:281-540-0057
Practice Address - Street 1:2424 W HOLCOMBE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1933
Practice Address - Country:US
Practice Address - Phone:281-540-0053
Practice Address - Fax:281-540-0057
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4190204R00000X, 207R00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC20271Medicare UPIN
TX8C6222Medicare PIN