Provider Demographics
NPI:1023078912
Name:PATEL, AJAY (MD)
Entity type:Individual
Prefix:DR
First Name:AJAY
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 1:450 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-2857
Mailing Address - Country:US
Mailing Address - Phone:304-727-0016
Mailing Address - Fax:304-727-2929
Practice Address - Street 1:450 2ND ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2857
Practice Address - Country:US
Practice Address - Phone:304-727-0016
Practice Address - Fax:304-727-2929
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1804439000Medicaid
WV1804439000Medicaid
WVG13539Medicare UPIN