Provider Demographics
NPI:1629033949
Name:PATEL, VIJAY C (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:C
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 1:1038 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1120
Mailing Address - Country:US
Mailing Address - Phone:413-739-1100
Mailing Address - Fax:413-735-1130
Practice Address - Street 1:1038 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2135
Practice Address - Country:US
Practice Address - Phone:413-739-1100
Practice Address - Fax:413-735-1130
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1310097Medicaid
MA3968488OtherAETNA
MA19311OtherHNE #
743468OtherCONNECTICARE
MA9720719OtherCIGNA #
MAMP0365571AROtherCSR #
MA000000029989OtherHEALTHNET
MA0034745OtherNHP #
MA04-08503OtherEVERCARE
MAJ16223OtherBC/BS #
MAJ16223OtherBC/BS #
MAMP0365571AROtherCSR #
743468OtherCONNECTICARE
MA1310097Medicaid