Provider Demographics
NPI:1881919546
Name:PATEL, SURESHCHANDRA S (MD)
Entity type:Individual
Prefix:
First Name:SURESHCHANDRA
Middle Name:S
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 1:131 MELHORN RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5516
Mailing Address - Country:US
Mailing Address - Phone:718-983-6357
Mailing Address - Fax:718-701-3706
Practice Address - Street 1:131 MELHORN RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5516
Practice Address - Country:US
Practice Address - Phone:718-983-6357
Practice Address - Fax:718-701-3706
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine