Provider Demographics
NPI:1447268677
Name:PATEL, LOPA (MD)
Entity type:Individual
Prefix:DR
First Name:LOPA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3802
Mailing Address - Country:US
Mailing Address - Phone:973-783-5276
Mailing Address - Fax:973-783-6014
Practice Address - Street 1:160 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3802
Practice Address - Country:US
Practice Address - Phone:973-783-5276
Practice Address - Fax:973-783-6014
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07974200207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00789032OtherRR MEDICARE
NJ0102164Medicaid
NJ91002088001OtherAMERICHOICE
NJ91002088001OtherAMERICHOICE
NJ100362ZER8Medicare PIN