Provider Demographics
NPI:1750472817
Name:PATEL, KAMALESH P (MD)
Entity type:Individual
Prefix:MR
First Name:KAMALESH
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:405 12TH STREET EXT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2300
Mailing Address - Country:US
Mailing Address - Phone:304-425-7243
Mailing Address - Fax:304-487-3525
Practice Address - Street 1:405 12TH STREET EXT
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2300
Practice Address - Country:US
Practice Address - Phone:304-425-7243
Practice Address - Fax:304-487-3525
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20783207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVF13291Medicare UPIN
WV4090431Medicare PIN