Provider Demographics
NPI:1437136280
Name:PATEL, CHAGANLAL N (MD)
Entity type:Individual
Prefix:
First Name:CHAGANLAL
Middle Name:N
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 1:3000 GUERNSEY ST
Mailing Address - Street 2:SUITE 17
Mailing Address - City:BELLAIRE
Mailing Address - State:OH
Mailing Address - Zip Code:43906-1540
Mailing Address - Country:US
Mailing Address - Phone:740-676-4623
Mailing Address - Fax:740-671-6333
Practice Address - Street 1:3000 GUERNSEY ST
Practice Address - Street 2:SUITE 17
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-1540
Practice Address - Country:US
Practice Address - Phone:740-676-4623
Practice Address - Fax:740-671-6333
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035940P208D00000X
WV13016208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0226179Medicaid
WV0050592000Medicaid
WV0050592000Medicaid
C02458Medicare UPIN
OHPA7131811Medicare ID - Type Unspecified