Provider Demographics
NPI:1659338598
Name:PATEL, SUBODH G (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBODH
Middle Name:G
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:104 DELAWARE AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3100
Mailing Address - Country:US
Mailing Address - Phone:724-438-1300
Mailing Address - Fax:724-438-1400
Practice Address - Street 1:104 DELAWARE AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3100
Practice Address - Country:US
Practice Address - Phone:724-438-1300
Practice Address - Fax:724-438-1400
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD022718E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC33247Medicare UPIN
PA161629Medicare ID - Type Unspecified