Provider Demographics
NPI:1962978593
Name:PATEL, MEERA NILESH
Entity type:Individual
Prefix:
First Name:MEERA
Middle Name:NILESH
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12518 NE AIRPORT WAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1078
Mailing Address - Country:US
Mailing Address - Phone:503-256-2992
Mailing Address - Fax:503-258-0717
Practice Address - Street 1:12518 NE AIRPORT WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1078
Practice Address - Country:US
Practice Address - Phone:503-256-2992
Practice Address - Fax:503-258-0717
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56165363A00000X
ORPA201930207Q00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine