Provider Demographics
NPI:1932145422
Name:PATEL, NIRAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:NIRAJ
Middle Name:
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:PO BOX 2250
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23058-2250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2201 LOREINES LANDING CT
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233
Practice Address - Country:US
Practice Address - Phone:804-608-6812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232936207P00000X, 207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10125243Medicaid
VA010233003Medicaid
WV3810016102Medicaid
KY000000978600OtherANTHEM
VA010234492Medicaid
VA1932145422Medicaid
P00237235OtherRAILROAD MCR
VA010233003Medicaid
KYK139200Medicare PIN
VA014789V21Medicare PIN
H76842Medicare UPIN
VA1932145422Medicaid
00W214E06Medicare PIN
VAMC10759Medicare PIN
VA021327E98Medicare PIN
VA009410V01Medicare PIN
VA009311V67Medicare PIN