Provider Demographics
NPI:1205127172
Name:PATEL, VISHAL R (MD MBA)
Entity type:Individual
Prefix:
First Name:VISHAL
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD MBA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4735 OGLETOWN STANTON RD STE 12504735
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2072
Mailing Address - Country:US
Mailing Address - Phone:302-623-0200
Mailing Address - Fax:302-623-0275
Practice Address - Street 1:4735 OGLETOWN STANTON RD STE 1250
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2076
Practice Address - Country:US
Practice Address - Phone:302-623-0200
Practice Address - Fax:302-623-0275
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD042999208000000X, 207R00000X
DEC1-0010457207R00000X, 208000000X
MDD0079030207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics