Provider Demographics
NPI:1831156975
Name:PATEL, NIRUPAMA P (MD)
Entity type:Individual
Prefix:DR
First Name:NIRUPAMA
Middle Name:P
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4727
Mailing Address - Country:US
Mailing Address - Phone:361-664-8945
Mailing Address - Fax:361-664-8286
Practice Address - Street 1:415 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4727
Practice Address - Country:US
Practice Address - Phone:361-664-8945
Practice Address - Fax:361-664-8286
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3050208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112089101Medicaid