Provider Demographics
NPI:1649265489
Name:PATEL, AMITA R (MD)
Entity type:Individual
Prefix:DR
First Name:AMITA
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:627 S EDWIN C MOSES BLVD
Mailing Address - Street 2:5K
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45408-1461
Mailing Address - Country:US
Mailing Address - Phone:937-424-1000
Mailing Address - Fax:937-424-1002
Practice Address - Street 1:627 S EDWIN C MOSES BLVD
Practice Address - Street 2:5K
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408-1461
Practice Address - Country:US
Practice Address - Phone:937-424-1000
Practice Address - Fax:937-424-1002
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2022-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH350587902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0820580Medicaid
OHPA0688204Medicare ID - Type Unspecified
OH0820580Medicaid