Provider Demographics
NPI:1962576330
Name:PATEL, RINA A (MD)
Entity type:Individual
Prefix:
First Name:RINA
Middle Name:A
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 S LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-2792
Mailing Address - Country:US
Mailing Address - Phone:765-482-7005
Mailing Address - Fax:765-483-2517
Practice Address - Street 1:1310 S LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2792
Practice Address - Country:US
Practice Address - Phone:765-482-7005
Practice Address - Fax:765-483-2517
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07534400207Q00000X
WI50765207Q00000X
IN01072716A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0041939Medicaid
WI34931400Medicaid
WIWI1755003OtherMEDICARE INDIVIDUAL PTAN
WIWI1755OtherMEDICARE GROUP PTAN
IN300056527Medicaid