Provider Demographics
NPI:1306840897
Name:PATEL, CHANDULAL (MD)
Entity type:Individual
Prefix:
First Name:CHANDULAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:2001 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3915
Practice Address - Country:US
Practice Address - Phone:610-442-2082
Practice Address - Fax:610-438-2419
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA068440207UN0901X, 207RC0000X
PAMD066096-L207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20007943OtherAMERIHEALTH MERCY
PA985325OtherCIGNA PA
PA1774101OtherCAPITAL BLUE CROSS
PA2126271OtherAETNA US HEALTHCARE
PA381592OtherKEYSTONE CAPITAL
NJ8162808Medicaid
NJ1396504OtherHIGHMARK NJ
PA381592OtherHIGHMARK PA
PAP571485OtherOXFORD
PA1706660Medicaid
PAP571485OtherOXFORD
PA20007943OtherAMERIHEALTH MERCY
NJ8162808Medicaid