Provider Demographics
NPI:1679800700
Name:TUSHAR G. PATEL, M.D. P.C.
Entity Type:Organization
Organization Name:TUSHAR G. PATEL, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TUSHAR
Authorized Official - Middle Name:G
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-963-2231
Mailing Address - Street 1:253 GARY DR
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2682
Mailing Address - Country:US
Mailing Address - Phone:276-963-2231
Mailing Address - Fax:276-964-9701
Practice Address - Street 1:3150 CLINCH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2159
Practice Address - Country:US
Practice Address - Phone:276-963-2231
Practice Address - Fax:276-964-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006013198Medicaid
VA4660972OtherAETNA
VA0017933000OtherFEDERAL BLACK LUNG
VA030090OtherANTHEM BCBS
WV3810016951Medicaid
VAC10938Medicare PIN
VA030090OtherANTHEM BCBS
VA0017933000OtherFEDERAL BLACK LUNG