Healthcare Provider Details

I. General information

NPI: 1568459949
Provider Name (Legal Business Name): ANIL J PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MAPLEWOOD AVE
RONCEVERTE WV
24970-8016
US

IV. Provider business mailing address

1320 MAPLEWOOD AVE
RONCEVERTE WV
24970-8016
US

V. Phone/Fax

Practice location:
  • Phone: 304-647-4411
  • Fax: 304-295-8882
Mailing address:
  • Phone: 304-647-4411
  • Fax: 304-295-8882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number14147
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA44503
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.071595
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number35.071595
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: