Provider Demographics
NPI:1669451571
Name:PATEL, MAYUR C (MD)
Entity Type:Individual
Prefix:
First Name:MAYUR
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 1:2625 W ALAMEDA AVE
Mailing Address - Street 2:STE 506
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505
Mailing Address - Country:US
Mailing Address - Phone:818-843-5867
Mailing Address - Fax:818-843-5860
Practice Address - Street 1:2625 W ALAMEDA AVE
Practice Address - Street 2:STE 506
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505
Practice Address - Country:US
Practice Address - Phone:818-843-5864
Practice Address - Fax:818-843-5860
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA056296207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA562960Medicaid
CAOOA562960Medicaid
G16825Medicare UPIN