Provider Demographics
NPI:1912914102
Name:PATEL, BAKUL KUMAR
Entity Type:Individual
Prefix:
First Name:BAKUL
Middle Name:KUMAR
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 N MAIN ST STE G
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-2547
Mailing Address - Country:US
Mailing Address - Phone:345-728-1964
Mailing Address - Fax:434-572-8341
Practice Address - Street 1:1129 N MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-2547
Practice Address - Country:US
Practice Address - Phone:434-572-8196
Practice Address - Fax:434-572-8341
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101234858207RG0100X
NC2013-00007207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00064711OtherRR M CARE
OH1912914102Medicaid
VA010019087Medicaid
NC1912914102Medicaid
VA465809OtherANTHEM