Provider Demographics
NPI:1609048974
Name:PATEL, KETAN MAHENDRA (MD)
Entity Type:Individual
Prefix:
First Name:KETAN
Middle Name:MAHENDRA
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 1:1 MAIN ST
Mailing Address - Street 2:RIVERFRONT PARK, 13TH FLOOR
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1531
Mailing Address - Country:US
Mailing Address - Phone:617-231-2420
Mailing Address - Fax:617-231-2425
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:RIVERFRONT PARK, 13TH FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1531
Practice Address - Country:US
Practice Address - Phone:617-231-2420
Practice Address - Fax:617-231-2425
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine