Provider Demographics
NPI:1205942281
Name:PATEL, ANIL NANUBHAI (MD)
Entity type:Individual
Prefix:MR
First Name:ANIL
Middle Name:NANUBHAI
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 1:816 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE # 3C
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6010
Mailing Address - Country:US
Mailing Address - Phone:757-363-8838
Mailing Address - Fax:
Practice Address - Street 1:816 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE # 3C
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6010
Practice Address - Country:US
Practice Address - Phone:757-363-8838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042140207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5820596Medicaid
VA290000228Medicare ID - Type Unspecified
VAB05748Medicare UPIN