Provider Demographics
NPI:1780620484
Name:PATEL, NITIN C (MD)
Entity type:Individual
Prefix:
First Name:NITIN
Middle Name:C
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 26529
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86312-6529
Mailing Address - Country:US
Mailing Address - Phone:928-759-7009
Mailing Address - Fax:928-759-7041
Practice Address - Street 1:3185 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2240
Practice Address - Country:US
Practice Address - Phone:928-759-7009
Practice Address - Fax:928-759-7041
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24382174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
060055885OtherRAILROAD MEDICARE
AZAZ0861240OtherBCBS AZ
AZAZ0861240OtherBCBS AZ