Provider Demographics
NPI:1639260680
Name:PATEL, JITENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:JITENDRA
Middle Name:
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 1:1708 MERCHANTS HOPE CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455
Mailing Address - Country:US
Mailing Address - Phone:757-460-3076
Mailing Address - Fax:
Practice Address - Street 1:2020 S INDEPENDENCE BLVD
Practice Address - Street 2:STE 1
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453
Practice Address - Country:US
Practice Address - Phone:757-471-3100
Practice Address - Fax:757-471-3624
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6058949Medicaid
C20270Medicare UPIN
VA6058949Medicaid