Provider Demographics
NPI:1902860877
Name:PATEL, MAHESH B (MD)
Entity Type:Individual
Prefix:MR
First Name:MAHESH
Middle Name:B
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:240 MAIN STREET
Mailing Address - City:BRADSHAW
Mailing Address - State:WV
Mailing Address - Zip Code:24817-0240
Mailing Address - Country:US
Mailing Address - Phone:304-967-5034
Mailing Address - Fax:815-377-3542
Practice Address - Street 1:240 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRADSHAW
Practice Address - State:WV
Practice Address - Zip Code:24817
Practice Address - Country:US
Practice Address - Phone:304-967-5034
Practice Address - Fax:815-377-3542
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV16181207R00000X
VA45450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010059798Medicaid
WV0072908001Medicaid
WV0072908001Medicaid
WVPA0676891Medicare Oscar/Certification
WVPA0676892Medicare Oscar/Certification
VA010059798Medicaid