MEDICARE: MR. AMBRISH M PATEL PA-C

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	363A00000X	Physician Assistant	PA605	WY
2	363A00000X	Physician Assistant	013152	NY
3	363A00000X	Physician Assistant	0110008541	VA
4	363AM0700X	Medical Physician Assistant	PA06310	TX

General Provider Information

NPI Number	:	1710110457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AMBRISH M PATEL PA-C

Provider Business Mailing Address
First Line	:	2695 ROCKY MOUNTAIN AVE
Second Line	:	SUITE 150
City	:	LOVELAND
State	:	CO
Zip	:	80538-8702
Country	:	US
Telephone Number	:	970-624-4443
Fax Number	:	970-490-4175

Provider Business Practice Location Address
First Line	:	2500 POCOSHOCK PL STE 201
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-6345
Country	:	US
Telephone Number	:	804-276-9305
Fax Number	:

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

Provider Enumeration Date	:	08/28/2009
Last Update Date	:	04/03/2025

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