Provider Demographics
NPI:1427276757
Name:PATEL, ASHIT GAJENDRA (MD)
Entity type:Individual
Prefix:
First Name:ASHIT
Middle Name:GAJENDRA
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:777 COMMERCIAL ST SE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3421
Mailing Address - Country:US
Mailing Address - Phone:503-485-4787
Mailing Address - Fax:503-485-4789
Practice Address - Street 1:777 COMMERCIAL ST SE
Practice Address - Street 2:SUITE 103
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3421
Practice Address - Country:US
Practice Address - Phone:503-485-4787
Practice Address - Fax:503-485-4789
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD27631207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR218439Medicaid
OR218439Medicaid