Provider Demographics
NPI:1609316140
Name:PATEL, MAYANK (MD)
Entity Type:Individual
Prefix:
First Name:MAYANK
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:JBSA FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-292-5077
Mailing Address - Fax:210-292-7868
Practice Address - Street 1:30 COURTENAY DRIVE 326/MSC 592
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-4504
Practice Address - Country:US
Practice Address - Phone:843-876-4794
Practice Address - Fax:843-876-2126
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101265374207RC0000X, 208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice