Provider Demographics
NPI:1326338237
Name:TELEHEALTH SPECIALTY MEDICAL GROUP, PC
Entity type:Organization
Organization Name:TELEHEALTH SPECIALTY MEDICAL GROUP, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:800-792-5972
Mailing Address - Street 1:3400 DOUGLAS BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4281
Mailing Address - Country:US
Mailing Address - Phone:916-740-3721
Mailing Address - Fax:916-783-0513
Practice Address - Street 1:3400 DOUGLAS BLVD STE 225
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4283
Practice Address - Country:US
Practice Address - Phone:916-740-3721
Practice Address - Fax:916-783-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 207RI0200X
CA207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGA309BMedicare PIN
CAGA309AMedicare PIN