Healthcare Provider Details

I. General information

NPI: 1467747527
Provider Name (Legal Business Name): PRATIKKUMAR PATEL M.D.M.P.H
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PRATIK PATEL M.D.M.P.H.

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 PENNSYLVANIA AVE STE 401
CHARLESTON WV
25302-3390
US

IV. Provider business mailing address

6431 FANNIN ST SUITE 3.137
HOUSTON TX
77030-1501
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-1552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27506
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10040436
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number27506
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: