Active NPI
Prakash Maganbhai Patel, M.D
- Pediatrics Physician
- Vienna, WV
National Provider Identifier
1306832928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- WV16490
- Practice address
- 800 Grand Central Mall Ste 6
Vienna, WV 26105-4100 - Phone
- (304) 424-4531
- Fax
- (304) 424-4476
- NPI assigned
- Sep 20, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A047816 | CA | |
| Pediatrics Physician | 208000000X | WV16490 | WV | Primary |
Addresses
Primary practice location
800 Grand Central Mall Ste 6
Vienna, WV 26105-4100
Mailing address
800 Grand Central Mall Ste 6
Vienna, WV 26105-4100
Phone (304) 424-4531
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0107094000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A047816 | CA | MD | Pediatrics Physician |
| WV16490 | WV | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Camden Clark Memorial Hospital Corporation | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Parkersburg, WV
- NPI 1699704254
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571961600000",
"number": "1306832928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 GRAND CENTRAL MALL STE 6",
"city": "VIENNA",
"state": "WV",
"postal_code": "261054100",
"telephone_number": "304-424-4531",
"fax_number": "304-424-4476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 GRAND CENTRAL MALL STE 6",
"city": "VIENNA",
"state": "WV",
"postal_code": "261054100",
"telephone_number": "304-424-4531",
"fax_number": "304-424-4476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATEL",
"first_name": "PRAKASH",
"middle_name": "MAGANBHAI",
"name_prefix": "Dr.",
"credential": "M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-20",
"last_updated": "2019-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A047816",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WV",
"license": "WV16490",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0107094000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vienna, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.