Provider Demographics
NPI:1245491208
Name:PATEL, KIRAN ROSHAN (MD)
Entity type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:ROSHAN
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 1:330 MOUNT AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5502
Mailing Address - Country:US
Mailing Address - Phone:617-492-3500
Mailing Address - Fax:
Practice Address - Street 1:3156 VISTA WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3622
Practice Address - Country:US
Practice Address - Phone:760-547-8000
Practice Address - Fax:760-547-8001
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPENDING2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology