Healthcare Provider Details

I. General information

NPI: 1174084750
Provider Name (Legal Business Name): BADAR PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W MACARTHUR BLVD
OAKLAND CA
94611-5641
US

IV. Provider business mailing address

3600 BROADWAY FL 3
OAKLAND CA
94611-5730
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-1000
  • Fax:
Mailing address:
  • Phone: 510-752-1000
  • Fax: 510-752-7456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA205794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: