Basic Information
| Provider Information | |||||||||
| NPI: | 1679676555 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | CHANDRAKANT | ||||||||
| MiddleName: | DASBHAI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 HULL STREET | ||||||||
| Address2: | |||||||||
| City: | BEVERLY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019151453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789275525 | ||||||||
| FaxNumber: | 9789275525 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 HERRICK ST | ||||||||
| Address2: | BEVERLY HOSPITAL NORTH EAST HEALTH SYSTEM | ||||||||
| City: | BEVERLY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019151790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789223000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 11/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 36299 | MA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0005234 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 2044021 | 05 | MA | MEDICAID | V39504 | 01 | MA | NETWORK HEALTH | OTHER | 71427160001 | 01 | CIGNA | OTHER | 8766 | 01 | MA | HARVARD PILGRIM HEALTH CARE | OTHER | D03098 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | 004373130 | 01 | TX | AETNA | OTHER | 26778 | 01 | MA | FALLON COMMUNITY HEALTH PLAN | OTHER | 713883 | 01 | MA | TUFTS HEALTH PLAN | OTHER |