Provider Demographics
NPI:1053327726
Name:PATEL, NIMESH (MD)
Entity Type:Individual
Prefix:DR
First Name:NIMESH
Middle Name:
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 1:1930 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-2328
Mailing Address - Country:US
Mailing Address - Phone:267-570-5200
Mailing Address - Fax:215-279-9219
Practice Address - Street 1:1930 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2328
Practice Address - Country:US
Practice Address - Phone:267-570-5200
Practice Address - Fax:215-279-9219
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066908L208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2887885OtherAETNA HMO
PA0018743700001Medicaid
PA1155124OtherKEYSTONE MERCY
PA202580300OtherKEYSTONE HEALTH PLAN EAST
PA7343343OtherAETNA PPO
PA1333067OtherBLUE SHIELD
PA202580300OtherKEYSTONE HEALTH PLAN EAST
PA050732R81Medicare PIN