Provider Demographics
NPI:1245659648
Name:PATEL, MIT PRABHAKER (MD)
Entity type:Individual
Prefix:
First Name:MIT
Middle Name:PRABHAKER
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MIT
Other - Middle Name:P
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4000 COLISEUM DR STE 320
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5983
Mailing Address - Country:US
Mailing Address - Phone:757-827-2350
Mailing Address - Fax:757-510-9383
Practice Address - Street 1:4000 COLISEUM DR STE 320
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5983
Practice Address - Country:US
Practice Address - Phone:757-827-2350
Practice Address - Fax:757-510-9383
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101262014207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease