MEDICARE: LEELA K PATEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	18983	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	080143242	OTHER	WV	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5632473	OTHER	WV	AETNA
2	001720355	OTHER	WV	MS BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124097084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEELA K PATEL MD

Provider Business Mailing Address
First Line	:	3 CLAYMONT RD
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-2767
Country	:	US
Telephone Number	:	304-344-0850
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 DIVISION ST
Second Line	:	SUITE 306
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25309-1455
Country	:	US
Telephone Number	:	304-766-4300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	12/13/2012

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Directions to “ LEELA K PATEL MD” Practice Location

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