Provider Demographics
NPI:1457342420
Name:PATEL, SAMIR PRAVINCHANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:PRAVINCHANDRA
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14 FELLSMERE AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3681
Mailing Address - Country:US
Mailing Address - Phone:781-246-2747
Mailing Address - Fax:
Practice Address - Street 1:365 EAST ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1950
Practice Address - Country:US
Practice Address - Phone:781-306-6165
Practice Address - Fax:781-306-6146
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA760852084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA83588OtherUNITED BEH HEALTH
MA076805OtherTUFTS HEALTH PLAN
MA3112608Medicaid
MA076805OtherTUFTS HEALTH PLAN
MAF70643Medicare UPIN