Provider Demographics
NPI:1982722294
Name:SUBODH G. PATEL M.D.P.C.
Entity Type:Organization
Organization Name:SUBODH G. PATEL M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBODH
Authorized Official - Middle Name:G
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-438-1300
Mailing Address - Street 1:306 SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-5600
Mailing Address - Country:US
Mailing Address - Phone:724-439-8072
Mailing Address - Fax:724-438-1400
Practice Address - Street 1:104 DELAWARE AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3100
Practice Address - Country:US
Practice Address - Phone:724-438-1300
Practice Address - Fax:724-438-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022718E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA010889260003Medicaid