Provider Demographics
NPI:1174054696
Name:PATEL, SAMIK HETAL (MD)
Entity type:Individual
Prefix:DR
First Name:SAMIK
Middle Name:HETAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:667 KINGSBOROUGH SQ STE 101
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4999
Mailing Address - Country:US
Mailing Address - Phone:801-930-4362
Mailing Address - Fax:
Practice Address - Street 1:113 GAINSBOROUGH SQ STE 400
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1714
Practice Address - Country:US
Practice Address - Phone:757-842-4499
Practice Address - Fax:757-842-4490
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-26
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101279296208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program