Provider Demographics
NPI:1720022486
Name:PATEL, DEEPESH S (MD)
Entity Type:Individual
Prefix:
First Name:DEEPESH
Middle Name:S
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12602-0752
Mailing Address - Country:US
Mailing Address - Phone:845-473-8996
Mailing Address - Fax:845-473-8997
Practice Address - Street 1:15 FULTON AVE
Practice Address - Street 2:LL
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2315
Practice Address - Country:US
Practice Address - Phone:845-473-8996
Practice Address - Fax:845-473-8997
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223778207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02381482Medicaid
NY02381482Medicaid
NY52S171Medicare PIN