Provider Demographics
NPI:1255419602
Name:PATEL, AMRUT R (MD)
Entity type:Individual
Prefix:
First Name:AMRUT
Middle Name:R
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:PO BOX 7979
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-7900
Mailing Address - Country:US
Mailing Address - Phone:401-943-1616
Mailing Address - Fax:401-946-9054
Practice Address - Street 1:1370 CRANSTON ST
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6758
Practice Address - Country:US
Practice Address - Phone:401-943-1616
Practice Address - Fax:401-946-9054
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD6701207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9000083Medicaid
119000083Medicare ID - Type Unspecified
RI9000083Medicaid