Provider Demographics
NPI:1700827938
Name:PATEL, KANU (MD)
Entity Type:Individual
Prefix:DR
First Name:KANU
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 MONTVALE AVE
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3647
Mailing Address - Country:US
Mailing Address - Phone:781-279-2030
Mailing Address - Fax:781-279-2078
Practice Address - Street 1:92 MONTVALE AVE
Practice Address - Street 2:SUITE 2200
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3647
Practice Address - Country:US
Practice Address - Phone:781-279-2030
Practice Address - Fax:781-279-2078
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55972207R00000X
NH7381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA64613OtherHARVARD PILGRIM
MA04-04199OtherUNITED
MA110092930OtherRAILROAD MEDICARE/UNITED
MA3017575Medicaid
MA055972OtherTUFTS
MAJ05889OtherBLUE CROSS BLUE SHIELD
MAJ05889Medicare ID - Type Unspecified
MA64613OtherHARVARD PILGRIM