Provider Demographics
NPI:1033420419
Name:PATEL, NATHAN TUSHAR (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:TUSHAR
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 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:570-501-6368
Mailing Address - Fax:570-501-4754
Practice Address - Street 1:2838 ROUTE 611
Practice Address - Street 2:
Practice Address - City:TANNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18372-7923
Practice Address - Country:US
Practice Address - Phone:570-476-3336
Practice Address - Fax:570-839-7210
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16488208D00000X
PAMD477991207R00000X
MI4301097238207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
07031983OtherDOB