Provider Demographics
NPI:1386949063
Name:PATEL, GAURAVKUMAR SURESHBHAI (MD)
Entity type:Individual
Prefix:
First Name:GAURAVKUMAR
Middle Name:SURESHBHAI
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 1:605 SHARON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-1919
Mailing Address - Country:US
Mailing Address - Phone:724-773-4502
Mailing Address - Fax:
Practice Address - Street 1:605 SHARON RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-1919
Practice Address - Country:US
Practice Address - Phone:724-773-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD441762207RC0000X, 207RI0011X
SC39864207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025710660003Medicaid
SC398643Medicaid
SC398643Medicaid