Basic Information
| Provider Information | |||||||||
| NPI: | 1316187263 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | TEJAS | ||||||||
| MiddleName: | NAVIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PATEL | ||||||||
| OtherFirstName: | TEJAS | ||||||||
| OtherMiddleName: | NAVINCHANDRA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2450 W HUNTING PARK AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191291302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157077237 | ||||||||
| FaxNumber: | 2157079389 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 N BROAD ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191405103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157077237 | ||||||||
| FaxNumber: | 2157079389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2009 | ||||||||
| LastUpdateDate: | 12/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD450209 | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 46123 | AZ | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085B0100X | 46123 | AZ | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085U0001X | 46123 | AZ | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
| ID | Type | State | Issuer | Description | 005472 | 01 | AZ | GROUP MEDICAID ID | OTHER | 706543 | 05 | AZ | MEDICAID | ZWCBBM | 01 | AZ | GROUP MEDICARE ID | OTHER | CS7943 | 01 | AZ | GROUP MEDICARE RAILROAD ID & PTAN | OTHER | P01080312 | 01 | AZ | MEDICARE RAILROAD | OTHER | 1841261989 | 01 | AZ | GROUP NPI | OTHER | 1316187263 | 01 | AZ | PHYSICIAN INDIVIDUAL NPI | OTHER |