Healthcare Provider Details

I. General information

NPI: 1164480794
Provider Name (Legal Business Name): TUSHAR RAMESCHANDRA PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/22/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING NUMBER 2487, CARRINGTON RD.
FT. BLISS TX
79906
US

IV. Provider business mailing address

1131 EAGLE RIDGE DR
EL PASO TX
79912-7476
US

V. Phone/Fax

Practice location:
  • Phone: 915-742-3014
  • Fax: 915-742-2161
Mailing address:
  • Phone: 915-742-3014
  • Fax: 915-742-2161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101239181
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: