Healthcare Provider Details

I. General information

NPI: 1144384777
Provider Name (Legal Business Name): SURESH AMBALAL PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 MARION AVE NW STE 100
MASSILLON OH
44646-3639
US

IV. Provider business mailing address

323 MARION AVE NW STE 100
MASSILLON OH
44646-3639
US

V. Phone/Fax

Practice location:
  • Phone: 330-493-3313
  • Fax: 330-493-6413
Mailing address:
  • Phone: 330-493-3313
  • Fax: 330-493-6413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35047644P
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: