Provider Demographics
NPI:1710903430
Name:PATEL, MRUGENDRA RAOJIBHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:MRUGENDRA
Middle Name:RAOJIBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11314
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4004
Mailing Address - Country:US
Mailing Address - Phone:757-842-4481
Mailing Address - Fax:757-312-3135
Practice Address - Street 1:300 MEDICAL PKWY STE 212
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4985
Practice Address - Country:US
Practice Address - Phone:276-964-7434
Practice Address - Fax:276-963-3917
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010418772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
280304OtherANTHEM
VA006103243Medicaid
VA130024473Medicare PIN
280304OtherANTHEM
VA006103243Medicaid