Provider Demographics
NPI:1689752644
Name:PATEL, MANALI R (MD)
Entity Type:Individual
Prefix:
First Name:MANALI
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3636 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3236
Mailing Address - Country:US
Mailing Address - Phone:757-650-2725
Mailing Address - Fax:770-573-9513
Practice Address - Street 1:3636 HIGH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707
Practice Address - Country:US
Practice Address - Phone:757-650-2725
Practice Address - Fax:770-573-9513
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYTP859207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101248147OtherBOARD OF MEDICINE LICENSE TO PRACTICE
KYTP859OtherKY MEDICAL LICENSE
IN01062888AOtherINDIANA MEDICAL LICENSE