Provider Demographics
NPI:1669465357
Name:PATEL, NITIN K (MD)
Entity Type:Individual
Prefix:DR
First Name:NITIN
Middle Name:K
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 1:461 NILES CORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484
Mailing Address - Country:US
Mailing Address - Phone:330-856-1154
Mailing Address - Fax:330-856-6966
Practice Address - Street 1:461 NILES CORTLAND RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484
Practice Address - Country:US
Practice Address - Phone:330-856-1154
Practice Address - Fax:330-856-6966
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0749364Medicaid
OHPA0641793Medicare ID - Type Unspecified
OH0749364Medicaid