Provider Demographics
NPI:1932354156
Name:PATEL, ANKUR SURESHCHANDRA (MD)
Entity Type:Individual
Prefix:
First Name:ANKUR
Middle Name:SURESHCHANDRA
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 1:2445 S DELSEA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-7000
Mailing Address - Country:US
Mailing Address - Phone:856-418-5433
Mailing Address - Fax:
Practice Address - Street 1:500 J CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1929
Practice Address - Country:US
Practice Address - Phone:757-594-3580
Practice Address - Fax:757-594-3653
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249807207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01085678Medicare PIN
VA1932354156Medicaid
VAVV4420BMedicare PIN