Provider Demographics
NPI:1295743433
Name:PATEL, MUKESH P (MD)
Entity type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:P
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 1:400 E BURWELL ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-4338
Mailing Address - Country:US
Mailing Address - Phone:540-387-3105
Mailing Address - Fax:540-387-3653
Practice Address - Street 1:400 E BURWELL ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-4338
Practice Address - Country:US
Practice Address - Phone:540-387-3105
Practice Address - Fax:540-387-3653
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010358812084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
395222OtherANTHEM/ANTHEM HEALTHKEEP
019414OtherVALUE OPTIONS
095931000OtherMAGELLAN
63859OtherCIGNA
541925036OtherUBH/UHC
4236869OtherAETNA
425445OtherMAMSI, MDIPA
VA007111355Medicaid
089935OtherSENTARA/SOUTHERN HEALTH
4236869OtherAETNA
VAB07918Medicare UPIN