Provider Demographics
NPI:1336195155
Name:PATEL, GARGI SHARAD (MD)
Entity Type:Individual
Prefix:DR
First Name:GARGI
Middle Name:SHARAD
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 WOODLANDS PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3462
Mailing Address - Country:US
Mailing Address - Phone:727-781-3888
Mailing Address - Fax:727-784-0616
Practice Address - Street 1:4133 WOODLANDS PKWY
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3462
Practice Address - Country:US
Practice Address - Phone:727-781-3888
Practice Address - Fax:727-784-0616
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME453202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54112Medicare UPIN
FL30754Medicare ID - Type Unspecified