Provider Demographics
NPI:1942273602
Name:PATEL, BHAVESH M (MD)
Entity Type:Individual
Prefix:
First Name:BHAVESH
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 1:1603 SANTA ROSA RD
Mailing Address - Street 2:RM 102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5010
Mailing Address - Country:US
Mailing Address - Phone:804-288-6750
Mailing Address - Fax:804-299-6753
Practice Address - Street 1:7605 FOREST AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4938
Practice Address - Country:US
Practice Address - Phone:804-285-6390
Practice Address - Fax:804-285-6393
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47066207RN0300X
VA0101246729207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV0823BOtherMEDICARE PROVIDER PTAN
F84556Medicare UPIN
390000365Medicare ID - Type Unspecified