MEDICARE: DR. SURESHCHANDRA GANGARAM 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	208000000X	Pediatrics Physician	190163	NY

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	:	1871589739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURESHCHANDRA GANGARAM PATEL M.D

Provider Business Mailing Address
First Line	:	17 CHAFFEE AVE
Second Line	:
City	:	ALBERTSON
State	:	NY
Zip	:	11507-1807
Country	:	US
Telephone Number	:	718-439-9620
Fax Number	:	718-439-3289

Provider Business Practice Location Address
First Line	:	5801 5TH AVE
Second Line	:	MEDICAL DENTAL OFFICE
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3819
Country	:	US
Telephone Number	:	718-439-9620
Fax Number	:	718-439-3289

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	07/06/2014

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