Provider Demographics
NPI:1922012103
Name:PATEL, TUSHAR RAMAN (MD)
Entity Type:Individual
Prefix:
First Name:TUSHAR
Middle Name:RAMAN
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 1:132 GATEWAY BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5540
Mailing Address - Country:US
Mailing Address - Phone:704-663-7226
Mailing Address - Fax:704-662-3875
Practice Address - Street 1:132 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5540
Practice Address - Country:US
Practice Address - Phone:704-663-7226
Practice Address - Fax:704-662-3875
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004-00072207W00000X
NC200400072174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89136CGMedicaid
NC89136CGMedicaid
NCH02014Medicare UPIN