Provider Demographics
NPI:1790007789
Name:MRUGENDRA R PATEL M D P C
Entity Type:Organization
Organization Name:MRUGENDRA R PATEL M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MRUGENDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-964-7434
Mailing Address - Street 1:2951 FRONT ST
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2055
Mailing Address - Country:US
Mailing Address - Phone:276-964-7434
Mailing Address - Fax:276-963-3917
Practice Address - Street 1:2951 FRONT ST
Practice Address - Street 2:SUITE 2400
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2055
Practice Address - Country:US
Practice Address - Phone:276-964-7434
Practice Address - Fax:276-963-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010418772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006103243Medicaid
VA280304OtherANTHEM
VA006103243Medicaid
VA130024473Medicare PIN
VAVV0831AMedicare PIN