Healthcare Provider Details

I. General information

NPI: 1811524556
Provider Name (Legal Business Name): MAYANK PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 TOWNE LAKE PL
MONTGOMERY AL
36117-6013
US

IV. Provider business mailing address

473 TOWNE LAKE PL
MONTGOMERY AL
36117-6013
US

V. Phone/Fax

Practice location:
  • Phone: 334-450-3102
  • Fax:
Mailing address:
  • Phone: 334-450-3102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME162153
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number51023
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: