Provider Demographics
NPI:1598883068
Name:PATEL, CHANDRAVADAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRAVADAN
Middle Name:P
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 1:809 COSHOCTON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1900
Mailing Address - Country:US
Mailing Address - Phone:740-397-1900
Mailing Address - Fax:740-397-1900
Practice Address - Street 1:809 COSHOCTON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1900
Practice Address - Country:US
Practice Address - Phone:740-397-1900
Practice Address - Fax:740-397-1900
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350516072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0622820Medicaid
OHPA0580202Medicare ID - Type Unspecified
OH0622820Medicaid