Provider Demographics
NPI:1669649547
Name:PATEL, RAHUL S (DO)
Entity Type:Individual
Prefix:
First Name:RAHUL
Middle Name:S
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1800 CANNON DR FL 10
Mailing Address - Street 2:OHIO STATE UNIV COUNSELING AND CONSULTATION SERV
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-2209
Mailing Address - Country:US
Mailing Address - Phone:614-292-5766
Mailing Address - Fax:
Practice Address - Street 1:1800 CANNON DR FL 10
Practice Address - Street 2:OHIO STATE UNIV COUNSELING AND CONSULTATION SERVICE
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-2209
Practice Address - Country:US
Practice Address - Phone:614-292-5766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-10
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0097742084P0800X
IL036.1287392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHXP1826998OtherBUPRENORPHINE WAIVER