Provider Demographics
NPI:1407170632
Name:SANJAY A PATEL MD PA
Entity type:Organization
Organization Name:SANJAY A PATEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KASHMIRA
Authorized Official - Middle Name:SANJAY
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-732-6400
Mailing Address - Street 1:419 SW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0609
Mailing Address - Country:US
Mailing Address - Phone:352-732-6400
Mailing Address - Fax:352-671-5283
Practice Address - Street 1:419 SW 15TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0609
Practice Address - Country:US
Practice Address - Phone:352-732-6400
Practice Address - Fax:352-671-5283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272508800Medicaid
FL27591OtherMEDICARE PROVIDER NUMBER
FLG11717OtherUPIN
FL69007OtherME LICENSE
10D0974350OtherCLIA ID
FL1003866823OtherNPI ENTITY TYPE ONE ID
FL110204280OtherRAILROAD MEDICARE ID
FLBP4583325OtherDEA