Provider Demographics
NPI:1639172364
Name:PATEL, PRAFULLA N (MD)
Entity Type:Individual
Prefix:
First Name:PRAFULLA
Middle Name:N
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3904
Mailing Address - Country:US
Mailing Address - Phone:740-687-6360
Mailing Address - Fax:740-687-9125
Practice Address - Street 1:623 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3904
Practice Address - Country:US
Practice Address - Phone:740-687-6360
Practice Address - Fax:740-687-9125
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046285207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0479076Medicaid
OHCO2270Medicare UPIN
OH0479076Medicaid