Healthcare Provider Details

I. General information

NPI: 1265400865
Provider Name (Legal Business Name): VISHNU A PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MERCER ST
PRINCETON WV
24740-3029
US

IV. Provider business mailing address

1155 MERCER ST
PRINCETON WV
24740-3029
US

V. Phone/Fax

Practice location:
  • Phone: 304-431-7000
  • Fax:
Mailing address:
  • Phone: 304-431-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number19058
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: