Provider Demographics
NPI:1407898828
Name:JAYANT R. PATEL, MD, LLC
Entity Type:Organization
Organization Name:JAYANT R. PATEL, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYANT
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-785-9595
Mailing Address - Street 1:501 BATH RD
Mailing Address - Street 2:SUITE 209A
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-3101
Mailing Address - Country:US
Mailing Address - Phone:215-785-9595
Mailing Address - Fax:215-785-9891
Practice Address - Street 1:501 BATH RD
Practice Address - Street 2:SUITE 209A
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-3101
Practice Address - Country:US
Practice Address - Phone:215-785-9595
Practice Address - Fax:215-785-9891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037709L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
533330OtherAETNA
PADE5449OtherRAILROAD MEDICARE
099148Medicare ID - Type Unspecified