Provider Demographics
NPI:1740279009
Name:PATEL, JAY U (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:U
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:PO BOX 415250
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5250
Mailing Address - Country:US
Mailing Address - Phone:610-644-8900
Mailing Address - Fax:484-924-0053
Practice Address - Street 1:2929 LAKE PARK DR
Practice Address - Street 2:
Practice Address - City:LAKE SPIVEY
Practice Address - State:GA
Practice Address - Zip Code:30236-4131
Practice Address - Country:US
Practice Address - Phone:773-726-2682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010588262085R0202X
GA0792162085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200484790Medicaid
INH84991Medicare UPIN
IN211520 JMedicare ID - Type Unspecified