Provider Demographics
NPI:1023181153
Name:P N PATEL M.D P.C.
Entity Type:Organization
Organization Name:P N PATEL M.D P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PURSHOTTAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-286-0330
Mailing Address - Street 1:1214A LINE STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801
Mailing Address - Country:US
Mailing Address - Phone:570-286-0330
Mailing Address - Fax:570-286-5302
Practice Address - Street 1:1214A LINE STREET
Practice Address - Street 2:SUITE B
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801
Practice Address - Country:US
Practice Address - Phone:570-286-0330
Practice Address - Fax:570-286-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037501L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1959539OtherHIGHMARK BLUE SHIELD
PA0006789640001Medicaid
PA7046415OtherGATEWAY
PA0006789640004Medicaid
PA01077301OtherCAPITAL BLUE CROSS
PA0006789640001Medicaid
PAB96786Medicare UPIN