Healthcare Provider Details

I. General information

NPI: 1720578230
Provider Name (Legal Business Name): SAGAR PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

1420 JEFFERSON DR
FLORENCE SC
29501-5328
US

V. Phone/Fax

Practice location:
  • Phone: 317-850-2492
  • Fax:
Mailing address:
  • Phone: 317-850-2492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number36991
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: