Provider Demographics
NPI:1548236243
Name:PATEL, SHARAD S (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARAD
Middle Name:S
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S. BUENA VISTA ST.
Mailing Address - Street 2:SUITE 440
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505
Mailing Address - Country:US
Mailing Address - Phone:818-842-7778
Mailing Address - Fax:818-842-2086
Practice Address - Street 1:201 S. BUENA VISTA ST.
Practice Address - Street 2:SUITE 440
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505
Practice Address - Country:US
Practice Address - Phone:818-842-7778
Practice Address - Fax:818-842-2086
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25839173000000X
CAA25831207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A258390Medicaid
P00334637OtherPTAN (RAILROAD MCARE)
CAA24596Medicare UPIN
CAWA25839AMedicare PIN
WA25839AMedicare PIN