Provider Demographics
NPI:1013998004
Name:PATEL, RAKESHKUMAR BHAGWANDAS (MD, MBA)
Entity Type:Individual
Prefix:
First Name:RAKESHKUMAR
Middle Name:BHAGWANDAS
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:RAKESH
Other - Middle Name:BHAGWANDAS
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MBA
Mailing Address - Street 1:805 QUAIL RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-5064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1025 EXECUTIVE PARK BLVD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4620
Practice Address - Country:US
Practice Address - Phone:423-830-8110
Practice Address - Fax:423-473-1102
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD41317207R00000X, 2084P0800X
VA01012386772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ029152Medicaid
TNQ004992Medicaid
P00877921OtherRR MEDICARE
VA1013998004Medicaid
TN81127000OtherMAGELLAN
P00877921OtherRR MEDICARE
VA1013998004Medicaid