Basic Information
| Provider Information | |||||||||
| NPI: | 1598710279 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | TEJAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2365 S CLINTON AVE | ||||||||
| Address2: | SUITE #100 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146182663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854425320 | ||||||||
| FaxNumber: | 5854425526 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 CANAL LANDING BLVD | ||||||||
| Address2: | SUITE #8 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146265109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852397300 | ||||||||
| FaxNumber: | 5852277723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 08/04/2016 | ||||||||
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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 | 207R00000X | 210309 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 210309 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 210309 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 210309 1W CIM CUD | 01 | WORKERS COMP | OTHER | 02068817 | 05 | NY | MEDICAID |