Provider Demographics
NPI:1962428169
Name:PATEL, RAVINDRA (MD)
Entity type:Individual
Prefix:
First Name:RAVINDRA
Middle Name:
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 1:111 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3967
Mailing Address - Country:US
Mailing Address - Phone:732-452-9700
Mailing Address - Fax:732-452-9720
Practice Address - Street 1:42 THROCKMORTON LN
Practice Address - Street 2:2ND FLOOR
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2572
Practice Address - Country:US
Practice Address - Phone:732-607-1111
Practice Address - Fax:732-607-9306
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA043941207RC0000X, 207RG0300X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
420930Medicare PIN
NJE91868Medicare UPIN