Provider Demographics
NPI:1467594986
Name:PATEL, TARULATA M (MD)
Entity Type:Individual
Prefix:
First Name:TARULATA
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 NORMANDY DRIVE SUITE #3
Mailing Address - Street 2:LIBERTY MEDICAL CENTER
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077
Mailing Address - Country:US
Mailing Address - Phone:440-953-3872
Mailing Address - Fax:440-354-2721
Practice Address - Street 1:50 NORMANDY DRIVE SUITE #3
Practice Address - Street 2:LIBERTY MEDICAL CENTER
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077
Practice Address - Country:US
Practice Address - Phone:440-953-3872
Practice Address - Fax:440-354-2721
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH391232081P2900X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000128112OtherANTHEM
PA0769261Medicare UPIN
OHM927071Medicare ID - Type Unspecified