Provider Demographics
NPI:1902825441
Name:PATEL, ASHOK JIVANLAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHOK
Middle Name:JIVANLAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2100 DORCHESTER AVE
Mailing Address - Street 2:SETON MEDICAL BUILDING-SUITE 303
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124
Mailing Address - Country:US
Mailing Address - Phone:617-296-0720
Mailing Address - Fax:617-296-5166
Practice Address - Street 1:2110 DORCHESTER AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5628
Practice Address - Country:US
Practice Address - Phone:617-296-0720
Practice Address - Fax:617-296-5166
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA52194207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04-05063OtherEVERCARE
MA0030542OtherNEIGHBORHOOD HEALTH PLAN
MA4488345OtherAETNA
MA030506866OtherCIGNA AARP COMMONWLTH
MA3127303Medicaid
MAP00057680OtherRAILROAD MEDICARE
MA052194OtherTUFTS HEALTH PLAN
MA64369OtherHARVARD PILGRIM HLTH CARE
MAJ30545OtherBLUE CROSS BLUE SHIELD
MA052194OtherTUFTS HEALTH PLAN
MA64369OtherHARVARD PILGRIM HLTH CARE
MA04-05063OtherEVERCARE