Provider Demographics
NPI:1861570558
Name:PATEL, CHAULA P (MD)
Entity type:Individual
Prefix:
First Name:CHAULA
Middle Name:P
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MCGEORY AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10708-6615
Mailing Address - Country:US
Mailing Address - Phone:718-733-6369
Mailing Address - Fax:718-294-4365
Practice Address - Street 1:1560 GRAND CONCOURSE
Practice Address - Street 2:SUITE 102
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-8402
Practice Address - Country:US
Practice Address - Phone:718-733-6369
Practice Address - Fax:718-294-4365
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY203633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01740909Medicaid
NY01740909Medicaid
NYG46013Medicare UPIN