Provider Demographics
NPI:1487857025
Name:PATEL, SUNDIP S (DO)
Entity Type:Individual
Prefix:DR
First Name:SUNDIP
Middle Name:S
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
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 8427
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-8427
Mailing Address - Country:US
Mailing Address - Phone:252-847-2181
Mailing Address - Fax:
Practice Address - Street 1:2119 E SOUTH BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2454
Practice Address - Country:US
Practice Address - Phone:334-613-7070
Practice Address - Fax:334-613-7072
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1524208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL181044Medicaid
AL102I345019OtherMEDICARE
AL511-74662OtherBCBS OF AL