Basic Information
Provider Information
NPI: 1003139171
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: AMOL
MiddleName: ROHIT
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 570 W BROWN RD
Address2:  
City: MESA
State: AZ
PostalCode: 852013227
CountryCode: US
TelephoneNumber: 4803442028
FaxNumber:  
Practice Location
Address1: 570 W BROWN RD
Address2:  
City: MESA
State: AZ
PostalCode: 852013227
CountryCode: US
TelephoneNumber: 4803442028
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/03/2010
LastUpdateDate: 03/03/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XR71463AZY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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