Provider Demographics
NPI:1124097084
Name:PATEL, LEELA K (MD)
Entity type:Individual
Prefix:
First Name:LEELA
Middle Name:K
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CLAYMONT RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2767
Mailing Address - Country:US
Mailing Address - Phone:304-344-0850
Mailing Address - Fax:
Practice Address - Street 1:401 DIVISION ST
Practice Address - Street 2:SUITE 306
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1455
Practice Address - Country:US
Practice Address - Phone:304-766-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5632473OtherAETNA
WV001720355OtherMS BCBS
WV0055016000Medicaid
WV080143242OtherRR MEDICARE
WV2019631Medicare PIN
WV0055016000Medicaid
WV2019634Medicare PIN
WV080143242OtherRR MEDICARE
WV2019635Medicare PIN
WV2019633Medicare PIN