Provider Demographics
NPI:1568550127
Name:PATEL, SANJAY RAMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:RAMAN
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1521 N CARPENTER RD
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-1147
Mailing Address - Country:US
Mailing Address - Phone:209-575-7520
Mailing Address - Fax:209-575-7515
Practice Address - Street 1:1521 N CARPENTER RD
Practice Address - Street 2:SUITE D-1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-1147
Practice Address - Country:US
Practice Address - Phone:209-575-7520
Practice Address - Fax:209-575-7515
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG80499225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
G87499Medicare UPIN