Provider Demographics
NPI:1760436083
Name:PATEL, DILIPKUMAR R (MD)
Entity Type:Individual
Prefix:
First Name:DILIPKUMAR
Middle Name:R
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 1065
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-1065
Mailing Address - Country:US
Mailing Address - Phone:262-788-9272
Mailing Address - Fax:262-788-9298
Practice Address - Street 1:STATE RT 83
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614
Practice Address - Country:US
Practice Address - Phone:276-259-5100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010342822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007237804Medicaid
VA007237804Medicaid
00V486B58Medicare ID - Type Unspecified