=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144767898
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHISH RAVINDRA PATIL MD, PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2017
-----------------------------------------------------
Last Update Date | 04/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1910 E INNOVATION PARK DR
-----------------------------------------------------
City | ORO VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85755-1962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-449-0557
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1910 E INNOVATION PARK DR
-----------------------------------------------------
City | ORO VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85755-1962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-887-2155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZH0000X
-----------------------------------------------------
Taxonomy Name | Hematology (Pathology) Physician
-----------------------------------------------------
License Number | 68793
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207ZP0007X
-----------------------------------------------------
Taxonomy Name | Molecular Genetic Pathology (Pathology) Physician
-----------------------------------------------------
License Number | 68793
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207ZP0007X
-----------------------------------------------------
Taxonomy Name | Molecular Genetic Pathology (Pathology) Physician
-----------------------------------------------------
License Number | 321536
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 23-368
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207ZH0000X
-----------------------------------------------------
Taxonomy Name | Hematology (Pathology) Physician
-----------------------------------------------------
License Number | S-24-331
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 207ZH0000X
-----------------------------------------------------
Taxonomy Name | Hematology (Pathology) Physician
-----------------------------------------------------
License Number | 321536
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 68793
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #9
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 321536
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #10
-----------------------------------------------------
Taxonomy Code | 207ZP0007X
-----------------------------------------------------
Taxonomy Name | Molecular Genetic Pathology (Pathology) Physician
-----------------------------------------------------
License Number | A187591
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------