Provider Demographics
NPI:1861424285
Name:PATEL, PRAVIN I (MD)
Entity type:Individual
Prefix:DR
First Name:PRAVIN
Middle Name:I
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1322 LOCUST AVE
Mailing Address - Street 2:PO BOX 1112
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554
Mailing Address - Country:US
Mailing Address - Phone:304-366-0700
Mailing Address - Fax:304-366-9529
Practice Address - Street 1:1322 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-366-0700
Practice Address - Fax:304-366-9529
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV10239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV110087720OtherRR MEDICARE
WV505819OtherNATIONAL CAPITAL PPO
WV000058954OtherMT STATE BC/BS
WV0082810000Medicaid
WV0004420446OtherAETNA
WVFQ10239OtherHEALTH PLAN
WV0573008OtherHOME PLAN PEIA AND CHIPS
WVE19547OtherWV WORKER'S COMP
WVFQ10239OtherHEALTH PLAN
WV0573008OtherHOME PLAN PEIA AND CHIPS