Provider Demographics
NPI:1912973033
Name:PATEL, PRAGNESH H (MD)
Entity type:Individual
Prefix:
First Name:PRAGNESH
Middle Name:H
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 1:661 E ALTAMONTE DR
Mailing Address - Street 2:STE 315
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5105
Mailing Address - Country:US
Mailing Address - Phone:407-339-3002
Mailing Address - Fax:407-260-5039
Practice Address - Street 1:661 E ALTAMONTE DR
Practice Address - Street 2:STE 315
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5105
Practice Address - Country:US
Practice Address - Phone:407-339-3002
Practice Address - Fax:407-260-5039
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL70958207K00000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251420600Medicaid
FLF78613Medicare UPIN
32256Medicare PIN