Provider Demographics
NPI:1134281140
Name:PATEL, SHRITA M (MD)
Entity Type:Individual
Prefix:
First Name:SHRITA
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LANCASTER AVENUE
Mailing Address - Street 2:222 LANKENAU MOB SOUTH
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:610-649-1922
Mailing Address - Fax:610-649-2121
Practice Address - Street 1:100 LANCASTER AVENUE
Practice Address - Street 2:222 LANKENAU MOB SOUTH
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-649-1922
Practice Address - Fax:610-649-2121
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423446207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021995480001Medicaid
PA134579HK1Medicare PIN