Healthcare Provider Details

I. General information

NPI: 1225093990
Provider Name (Legal Business Name): CHANDRAKANT M PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD
RICHMOND VA
23249-2924
US

IV. Provider business mailing address

4756 SOUTHMOOR RD
NORTH CHESTERFIELD VA
23234-3748
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5411
  • Fax:
Mailing address:
  • Phone: 804-482-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number01010368780
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101036870
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: