Healthcare Provider Details

I. General information

NPI: 1598710279
Provider Name (Legal Business Name): TEJAN PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CANAL LANDING BLVD SUITE #8
ROCHESTER NY
14626-5109
US

IV. Provider business mailing address

2365 S CLINTON AVE SUITE #100
ROCHESTER NY
14618-2663
US

V. Phone/Fax

Practice location:
  • Phone: 585-239-7300
  • Fax: 585-227-7723
Mailing address:
  • Phone: 585-442-5320
  • Fax: 585-442-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number210309
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number210309
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number210309
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: