Provider Demographics
NPI:1104817808
Name:PATEL, MANOJ K (MD)
Entity type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424A WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-5638
Mailing Address - Country:US
Mailing Address - Phone:706-327-6296
Mailing Address - Fax:706-571-0036
Practice Address - Street 1:2424A WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5638
Practice Address - Country:US
Practice Address - Phone:706-327-6296
Practice Address - Fax:706-571-0036
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA48811207RN0300X
AL23383207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00871582CMedicaid
GA00871582FMedicaid
AL060010676OtherBC/BS
AL000055505Medicaid
GA00871582BMedicaid
52669915OtherUNITED HEALTHCARE
GA699150OtherBC/BS
GA00871582GMedicaid
390006997OtherRAILROAD MEDICARE
GA00871582BMedicaid
GA699150OtherBC/BS
GA39BDCBWMedicare PIN