Provider Demographics
NPI:1639497019
Name:DR PRAKASHCHANDRA PATEL MD INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR PRAKASHCHANDRA PATEL MD INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAKASHCHANDRA
Authorized Official - Middle Name:T
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-332-1815
Mailing Address - Street 1:315 N 3RD AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1916
Mailing Address - Country:US
Mailing Address - Phone:626-332-1815
Mailing Address - Fax:626-966-9685
Practice Address - Street 1:315 N 3RD AVE STE 306
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1916
Practice Address - Country:US
Practice Address - Phone:626-332-1815
Practice Address - Fax:626-966-9685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA034471207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMEDICARE #OtherA34471
CANPIOther1902987613