Provider Demographics
NPI:1861566606
Name:PATEL, TUSHAR C (MD)
Entity type:Individual
Prefix:
First Name:TUSHAR
Middle Name:C
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 1:459 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721
Mailing Address - Country:US
Mailing Address - Phone:508-679-0010
Mailing Address - Fax:508-672-4679
Practice Address - Street 1:1155 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-997-2900
Practice Address - Fax:508-991-4432
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51540207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI274212OtherBLUE SHIELD
MAPAJ05167OtherBLUE SHIELD
MAJ05167Medicare ID - Type Unspecified
D82905Medicare UPIN