Provider Demographics
NPI:1669440293
Name:PATEL, YASHWANT P (MD)
Entity Type:Individual
Prefix:
First Name:YASHWANT
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:207 ELK AVE S
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-3051
Mailing Address - Country:US
Mailing Address - Phone:931-433-2551
Mailing Address - Fax:931-433-1142
Practice Address - Street 1:207 ELK AVE S
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3051
Practice Address - Country:US
Practice Address - Phone:931-433-2551
Practice Address - Fax:931-433-1142
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD10177207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3162143Medicaid
TN1669440293Medicare NSC
B02926Medicare UPIN