Provider Demographics
NPI:1972090215
Name:SHITAL PATEL 14 MD PA
Entity type:Organization
Organization Name:SHITAL PATEL 14 MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHITAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-943-9331
Mailing Address - Street 1:454 FAUST LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4702
Mailing Address - Country:US
Mailing Address - Phone:832-308-0508
Mailing Address - Fax:832-844-0707
Practice Address - Street 1:1801 NORTH LOOP W STE 45
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1445
Practice Address - Country:US
Practice Address - Phone:832-308-0508
Practice Address - Fax:866-824-8763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty