Provider Demographics
NPI:1962667790
Name:PATEL, RAVI ASHOK (MD, MBA, FACP, FAHA)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:ASHOK
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD, MBA, FACP, FAHA
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 1685
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-1685
Mailing Address - Country:US
Mailing Address - Phone:760-242-4810
Mailing Address - Fax:760-242-4760
Practice Address - Street 1:15963 QUANTICO RD
Practice Address - Street 2:SUITE C
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-0839
Practice Address - Country:US
Practice Address - Phone:760-242-4810
Practice Address - Fax:760-242-4760
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2534062084N0400X, 2084V0102X
CAA1159022084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000533016001OtherHEALTHNOW
NY26-1147857OtherMULTIPLAN/PHCS
NY261147857OtherEMPIRE UHC
NYJ400040884OtherMEDICARE
NY110322000063OtherFIDELIS
NYBA1319OtherMEDICARE
NY3307884Medicaid
NY9701688OtherAETNA
NY1962667790OtherMVP
NY261147857OtherEXCELLUS BC/BS
NY261147857OtherPOMCO
NY200223508001OtherCDPHP
NY3307884Medicaid