Provider Demographics
NPI:1457351595
Name:PATIL, GARGEY MANOHAR (MD)
Entity Type:Individual
Prefix:
First Name:GARGEY
Middle Name:MANOHAR
Last Name:PATIL
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 1:235 E. PRINCETON STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804
Mailing Address - Country:US
Mailing Address - Phone:407-303-1444
Mailing Address - Fax:407-303-1424
Practice Address - Street 1:235 E. PRINCETON STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804
Practice Address - Country:US
Practice Address - Phone:407-303-1444
Practice Address - Fax:407-303-1424
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78130207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258546400Medicaid
H10476Medicare UPIN
FLE3642TMedicare PIN
FL258546400Medicaid