Healthcare Provider Details

I. General information

NPI: 1437136280
Provider Name (Legal Business Name): CHAGANLAL N. PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 GUERNSEY ST SUITE 17
BELLAIRE OH
43906-1540
US

IV. Provider business mailing address

3000 GUERNSEY ST SUITE 17
BELLAIRE OH
43906-1540
US

V. Phone/Fax

Practice location:
  • Phone: 740-676-4623
  • Fax: 740-671-6333
Mailing address:
  • Phone: 740-676-4623
  • Fax: 740-671-6333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35035940P
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13016
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: