Provider Demographics
NPI:1861478109
Name:PATEL, GOVINDBHAI M (MD)
Entity Type:Individual
Prefix:DR
First Name:GOVINDBHAI
Middle Name:M
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 1:1844 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1237
Mailing Address - Country:US
Mailing Address - Phone:304-366-1538
Mailing Address - Fax:306-763-4196
Practice Address - Street 1:1844 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1237
Practice Address - Country:US
Practice Address - Phone:304-366-1538
Practice Address - Fax:306-763-4196
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV13417OtherHEALTH PLAN
WV1023471OtherW COMP
WV0083889000Medicaid
WV1023471OtherW COMP
D49468Medicare UPIN