Provider Demographics
NPI:1982672192
Name:PATIL, SARLA RAJARAM (MD)
Entity Type:Individual
Prefix:
First Name:SARLA
Middle Name:RAJARAM
Last Name:PATIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARLA
Other - Middle Name:
Other - Last Name:PATIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1905 S-W H.K. DODGEN LOOP
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502
Mailing Address - Country:US
Mailing Address - Phone:254-298-2682
Mailing Address - Fax:254-778-7197
Practice Address - Street 1:1905 SW H K DODGEN LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1814
Practice Address - Country:US
Practice Address - Phone:254-298-2682
Practice Address - Fax:254-778-7197
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB147058OtherMEDICARE NUMBER
TX293950601Medicaid
TX293950601Medicaid