MEDICARE: JAGDISH H PATEL MD INC

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		OH

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	:	1912997164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAGDISH H PATEL MD INC

Provider Business Mailing Address
First Line	:	1455 PARKMAN RD NW
Second Line	:	JAGDISH H PATEL MD INC
City	:	WARREN
State	:	OH
Zip	:	44485-2156
Country	:	US
Telephone Number	:	330-394-3816
Fax Number	:	330-399-7295

Provider Business Practice Location Address
First Line	:	1455 PARKMAN RD NW
Second Line	:	JAGDISH H PATEL MD INC
City	:	WARREN
State	:	OH
Zip	:	44485-2156
Country	:	US
Telephone Number	:	330-394-3816
Fax Number	:	330-399-7295

Authorized Official
Title or Position	:	MD
Name	:	JAGDISH H PATEL
Credential	:	MD
Telephone Number	:	330-394-3816

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/21/2022

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