Provider Demographics
NPI:1871775734
Name:SPECIALIST IN INFECTIOUS DISEASES, LLC
Entity type:Organization
Organization Name:SPECIALIST IN INFECTIOUS DISEASES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANALI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-558-4687
Mailing Address - Street 1:1404 GUNSTON CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8100
Mailing Address - Country:US
Mailing Address - Phone:757-650-2725
Mailing Address - Fax:812-944-5403
Practice Address - Street 1:1404 GUNSTON CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-8100
Practice Address - Country:US
Practice Address - Phone:757-650-2725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200858870AMedicaid
KY64130487Medicaid
IN254700Medicare PIN
KY00520Medicare PIN