Provider Demographics
NPI:1962682609
Name:PATEL, SHASHIKANT R (MD)
Entity Type:Individual
Prefix:
First Name:SHASHIKANT
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 WASHINGTON VILLAGE DR
Mailing Address - Street 2:STE 220
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4094
Mailing Address - Country:US
Mailing Address - Phone:937-438-3132
Mailing Address - Fax:937-438-8707
Practice Address - Street 1:7700 WASHINGTON VILLAGE DR
Practice Address - Street 2:STE 230
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-438-3132
Practice Address - Fax:937-438-8707
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.095397207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3068979Medicaid
OHH000040Medicare PIN
OH4298321Medicare PIN
OH3068979Medicaid