MEDICARE: DR. PRADIP M PATEL M.D.

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	207R00000X	Internal Medicine Physician	25MA07004800	NJ

General Provider Information

NPI Number	:	1194044388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRADIP M PATEL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 38
Second Line	:	FEDERAL CORRECTIONAL INSTITUTION, HEALTH SERVICES DIV.
City	:	FORT DIX
State	:	NJ
Zip	:	08640-0902
Country	:	US
Telephone Number	:	609-723-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	5756 HARTFORD ROAD
Second Line	:
City	:	FORT DIX
State	:	NJ
Zip	:	08640-0902
Country	:	US
Telephone Number	:	609-723-1100
Fax Number	:

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

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	08/10/2011

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