Provider Demographics
NPI:1568459949
Name:PATEL, ANIL J (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:J
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 1:5508 GREENMONT TER
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-3296
Mailing Address - Country:US
Mailing Address - Phone:304-615-8100
Mailing Address - Fax:304-295-8882
Practice Address - Street 1:401 MATTHEW ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1635
Practice Address - Country:US
Practice Address - Phone:740-568-5427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44503207L00000X
WV14147207LP2900X
OH35.071595208VP0000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0064246000Medicaid
OH0600139Medicaid
0562195Medicare ID - Type Unspecified
0562198Medicare ID - Type Unspecified
WV0064246000Medicaid
OHH142060Medicare PIN
0562197Medicare ID - Type Unspecified
0562194Medicare ID - Type Unspecified