Provider Demographics
NPI:1710029715
Name:AJAY T PATEL MD INC
Entity Type:Organization
Organization Name:AJAY T PATEL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-727-0016
Mailing Address - Street 1:450 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-2857
Mailing Address - Country:US
Mailing Address - Phone:304-727-0016
Mailing Address - Fax:304-727-2929
Practice Address - Street 1:450 2ND ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2857
Practice Address - Country:US
Practice Address - Phone:304-727-0016
Practice Address - Fax:304-727-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1804439000Medicaid
9348841Medicare PIN
WV1804439000Medicaid