Provider Demographics
NPI:1912192576
Name:PATEL, SUDHIRKUMAR VINODCHANDRA (MD)
Entity Type:Individual
Prefix:
First Name:SUDHIRKUMAR
Middle Name:VINODCHANDRA
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 1:2000 BROOKSIDE DR
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4627
Mailing Address - Country:US
Mailing Address - Phone:423-857-5905
Mailing Address - Fax:423-857-5904
Practice Address - Street 1:2000 BROOKSIDE DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4627
Practice Address - Country:US
Practice Address - Phone:423-857-5905
Practice Address - Fax:423-857-5904
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42674207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1912192576Medicaid
TN1515080Medicaid
TN1515079Medicaid
NC1912192576Medicaid
TN4188131OtherBC/BS
KY7100036600Medicaid
TNQ002698Medicaid
TN1506080Medicaid
TN3000972Medicaid
NC5913115Medicaid
NC5913115Medicaid