Provider Demographics
NPI:1184705535
Name:PATEL, PRAHLAD M (MD)
Entity type:Individual
Prefix:DR
First Name:PRAHLAD
Middle Name:M
Last Name:PATEL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BERLIN CROSS KEYS ROAD
Mailing Address - Street 2:#102
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081
Mailing Address - Country:US
Mailing Address - Phone:856-875-5152
Mailing Address - Fax:856-872-4063
Practice Address - Street 1:600 CROSS KEYS RD
Practice Address - Street 2:#102
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-4147
Practice Address - Country:US
Practice Address - Phone:856-875-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05443800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1758802Medicaid
NJ1758802Medicaid
616068Medicare ID - Type Unspecified