MEDICARE: DR. JAY U 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	2085R0202X	Diagnostic Radiology Physician	01058826	IN
2	2085R0204X	Vascular & Interventional Radiology Physician	079216	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740279009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY U PATEL MD

Provider Business Mailing Address
First Line	:	PO BOX 415250
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-5250
Country	:	US
Telephone Number	:	610-644-8900
Fax Number	:	484-924-0053

Provider Business Practice Location Address
First Line	:	2929 LAKE PARK DR
Second Line	:
City	:	LAKE SPIVEY
State	:	GA
Zip	:	30236-4131
Country	:	US
Telephone Number	:	773-726-2682
Fax Number	:

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	11/18/2025

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