Provider Demographics
NPI:1275705345
Name:KETAN PATEL MDPC
Entity Type:Organization
Organization Name:KETAN PATEL MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KETANKUMAR
Authorized Official - Middle Name:V
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-237-2500
Mailing Address - Street 1:312 REGENCY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1618
Mailing Address - Country:US
Mailing Address - Phone:215-237-2500
Mailing Address - Fax:215-646-3466
Practice Address - Street 1:312 REGENCY DR
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-1618
Practice Address - Country:US
Practice Address - Phone:215-237-2500
Practice Address - Fax:215-646-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-29
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052448L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0073522570002Medicaid
PA766551OtherHIGH MARK BLUE CROSS
PA4559785OtherAETNA
PA0710600000OtherINDEPENDENCE BC/BS
PA238954OtherMHN
PA4559785OtherAETNA
PA0710600000OtherINDEPENDENCE BC/BS