Provider Demographics
NPI:1932192911
Name:PATEL, DEODUTT (MD)
Entity Type:Individual
Prefix:
First Name:DEODUTT
Middle Name:
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-441-1949
Mailing Address - Fax:740-446-5982
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5289
Practice Address - Fax:740-446-5697
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350521402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000231028OtherUNISON
OH4007747OtherAETNA
WV10024043OtherWV BWC
OH752766OtherBUCKEYE
WV3810017279Medicaid
OHP00662784OtherRAILROAD MEDICARE
OH000000550695OtherANTHEM
OH0593264Medicaid
OHPA4065957Medicare ID - Type Unspecified
OHP00662784OtherRAILROAD MEDICARE
OHE36634Medicare UPIN
OHPA4266912Medicare PIN