Provider Demographics
NPI:1871516302
Name:PATEL, VIRENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:VIRENDRA
Middle Name:
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 1:7451 S MASON MONTGOMERY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6818
Mailing Address - Country:US
Mailing Address - Phone:513-588-5640
Mailing Address - Fax:513-588-5649
Practice Address - Street 1:7451 S MASON MONTGOMERY RD
Practice Address - Street 2:SUITE C
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6818
Practice Address - Country:US
Practice Address - Phone:513-588-5640
Practice Address - Fax:513-588-5649
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.126712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01628154OtherBLUE CROSS BLUE SHIELD OF IL
IL036056559Medicaid
ILD14600Medicare UPIN
IL938530Medicare PIN