Provider Demographics
NPI:1407965577
Name:PATEL, MANOJKUMAR R (MD)
Entity Type:Individual
Prefix:DR
First Name:MANOJKUMAR
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2448 MILL ST
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-2234
Mailing Address - Country:US
Mailing Address - Phone:724-378-0591
Mailing Address - Fax:724-378-7339
Practice Address - Street 1:2448 MILL ST
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2234
Practice Address - Country:US
Practice Address - Phone:724-378-0591
Practice Address - Fax:724-378-7339
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016304E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000646737002Medicaid
PA164728Medicare ID - Type Unspecified
PA0265190001Medicare NSC
PAD71583Medicare UPIN