Healthcare Provider Details

I. General information

NPI: 1942592258
Provider Name (Legal Business Name): SACHIN VIJAY PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 PARK EAST DR STE 207
BEACHWOOD OH
44122-4309
US

IV. Provider business mailing address

3609 PARK EAST DR STE 207
BEACHWOOD OH
44122-4309
US

V. Phone/Fax

Practice location:
  • Phone: 216-360-0456
  • Fax: 216-360-9449
Mailing address:
  • Phone: 216-360-0456
  • Fax: 216-360-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberPATE4393848
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: