Provider Demographics
NPI:1598710279
Name:PATEL, TEJAN (MD)
Entity Type:Individual
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First Name:TEJAN
Middle Name:
Last Name:PATEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2365 S CLINTON AVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2663
Mailing Address - Country:US
Mailing Address - Phone:585-442-5320
Mailing Address - Fax:585-442-5526
Practice Address - Street 1:101 CANAL LANDING BLVD
Practice Address - Street 2:SUITE #8
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5109
Practice Address - Country:US
Practice Address - Phone:585-239-7300
Practice Address - Fax:585-227-7723
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2022-12-21
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Provider Licenses
StateLicense IDTaxonomies
NY210309207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02068817Medicaid
210309 1W CIM CUDOtherWORKERS COMP
NY02068817Medicaid
NYCC6508/ 70008A GRPMedicare PIN
NYRA 0143 / BA0017 GRPMedicare PIN