Provider Demographics
NPI:1528219201
Name:SANJAY B. PATEL, MD P.A.
Entity Type:Organization
Organization Name:SANJAY B. PATEL, MD P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:BALU
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-770-1182
Mailing Address - Street 1:3800 EDGESTONE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7966
Mailing Address - Country:US
Mailing Address - Phone:214-770-1182
Mailing Address - Fax:972-608-9868
Practice Address - Street 1:1650 W COLLEGE ST
Practice Address - Street 2:BOX 57
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3565
Practice Address - Country:US
Practice Address - Phone:214-770-1182
Practice Address - Fax:972-608-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A0367Medicare PIN
TXH45096Medicare UPIN