Provider Demographics
NPI:1134184310
Name:PATEL, NIMISH H (MD)
Entity type:Individual
Prefix:
First Name:NIMISH
Middle Name:H
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 1:3572 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3101
Mailing Address - Country:US
Mailing Address - Phone:724-728-6284
Mailing Address - Fax:724-728-7416
Practice Address - Street 1:1000 DUTCH RIDGE RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9727
Practice Address - Country:US
Practice Address - Phone:724-773-4567
Practice Address - Fax:724-728-9729
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350862132085R0202X
PAMD4302552085R0202X
VA01012823542085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018466000003Medicaid
OH2577742Medicaid
PAPA1964303OtherHIGHMARK BLUE CROSS/BLUE SHIELD
PA111850FUDMedicare PIN
OHI35286Medicare UPIN