Provider Demographics
NPI:1942229018
Name:PATEL, SUCHET R (MD)
Entity type:Individual
Prefix:
First Name:SUCHET
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:415 HOOPER RD
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-3698
Mailing Address - Country:US
Mailing Address - Phone:607-754-3863
Mailing Address - Fax:607-754-5697
Practice Address - Street 1:415 HOOPER ROAD
Practice Address - Street 2:ENDWELL FAMILY PHYSICIANS LLP
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-3698
Practice Address - Country:US
Practice Address - Phone:607-754-3863
Practice Address - Fax:607-754-5697
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY21788D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
126495OtherBLUEPOINT
126495OtherEMPIRE BS
88376OtherMVP SELECT
58144OtherGHI HMO
5998135OtherGHI
126495OtherEXCELLUS
126495OtherHMO BLUE
88376OtherMVP
NY0063724OtherCHAMPUS
126495OtherBS CNY
2353627OtherAETNA
749112OtherAETNA HMO
10046541OtherCDPHP
NY02143382Medicaid
126495OtherBS CNY
NYH22892Medicare UPIN