Provider Demographics
NPI:1407816721
Name:PATEL, PANKAJ HARJI (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:PANKAJ
Middle Name:HARJI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WALNUT ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5563
Mailing Address - Country:US
Mailing Address - Phone:215-955-6760
Mailing Address - Fax:215-923-8222
Practice Address - Street 1:2 CAPITAL WAY STE 356
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2521
Practice Address - Country:US
Practice Address - Phone:609-537-6000
Practice Address - Fax:609-537-6002
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-059559-L208600000X, 2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD683403500Medicaid
PA1758618OtherHIGHMARK BLUE SHIELD
PA20045808OtherAMERIHEALTH MERCY-WMG
PA001871486Medicaid
PA170856OtherUNISON-WMG
PA392055OtherMAMSI-WMG
PA50053498OtherCAPITAL BLUE CROSS-WMG
NJ8531901Medicaid
DE0001021401Medicaid
PA63568OtherGEISINGER
PA7391171OtherAETNA
PAP00251486OtherRAILROAD MEDICARE
MD647030OtherCAREFIRST MD BCBS
PA2423575000OtherAMERIHEALTH 65 PA
NY02316296Medicaid
PA1547026OtherGATEWAY-WMG
SCQ06003Medicaid
NY02316296Medicaid
PA1547026OtherGATEWAY-WMG
NJ8531901Medicaid