Provider Demographics
NPI:1265407241
Name:PATEL, NITINKUMAR K (MD)
Entity type:Individual
Prefix:
First Name:NITINKUMAR
Middle Name:K
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 2270
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965
Mailing Address - Country:US
Mailing Address - Phone:606-248-5191
Mailing Address - Fax:606-248-0651
Practice Address - Street 1:3501 W CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965
Practice Address - Country:US
Practice Address - Phone:606-248-5191
Practice Address - Fax:606-248-0651
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN417621Medicaid
KY64231459Medicaid
VA6044786Medicaid
VA6044786Medicaid
1386501Medicare ID - Type Unspecified