Provider Demographics
NPI:1144293036
Name:PATEL, SANJIV P (MD)
Entity type:Individual
Prefix:
First Name:SANJIV
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 MACK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5300
Mailing Address - Country:US
Mailing Address - Phone:513-774-2870
Mailing Address - Fax:513-774-2727
Practice Address - Street 1:2960 MACK RD STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5300
Practice Address - Country:US
Practice Address - Phone:513-774-2870
Practice Address - Fax:513-774-2633
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.073242207RC0200X, 207RS0012X
OH35073242207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2517495Medicaid
000000329261OtherBCBS OHIO
P00145359OtherRAILROAD MEDICARE
311138782028OtherCARESOURCE
OH4134401Medicare ID - Type UnspecifiedMEDICARE PROV # MASON
OH4134402Medicare ID - Type UnspecifiedMEDICARE PROV # EASTGATE
P00145359OtherRAILROAD MEDICARE
OHH12646Medicare UPIN