Provider Demographics
NPI:1821055625
Name:PATEL, PIYUSH R (MD)
Entity Type:Individual
Prefix:MR
First Name:PIYUSH
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 1:13880 BRADDOCK RD
Mailing Address - Street 2:STE 209
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121
Mailing Address - Country:US
Mailing Address - Phone:703-818-2772
Mailing Address - Fax:703-818-2773
Practice Address - Street 1:13880 BRADDOCK RD
Practice Address - Street 2:STE 209
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121
Practice Address - Country:US
Practice Address - Phone:703-818-2772
Practice Address - Fax:703-818-2773
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6004008Medicaid
VA110075325OtherRAILROAD MEDICARE
DC123423Medicare PIN
VA6004008Medicaid