Provider Demographics
NPI:1902399231
Name:PATEL, NISHANT U (MD)
Entity Type:Individual
Prefix:
First Name:NISHANT
Middle Name:U
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 1:3125 CONANT AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6527
Mailing Address - Country:US
Mailing Address - Phone:209-524-1668
Mailing Address - Fax:209-524-0014
Practice Address - Street 1:3125 CONANT AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6527
Practice Address - Country:US
Practice Address - Phone:209-524-1668
Practice Address - Fax:209-524-0014
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11019792A390200000X
CA173856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program