Provider Demographics
NPI:1417169541
Name:PATEL, VIRAL P (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRAL
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W HARRISBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-4848
Mailing Address - Country:US
Mailing Address - Phone:717-944-0491
Mailing Address - Fax:717-944-1436
Practice Address - Street 1:1025 W HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-4848
Practice Address - Country:US
Practice Address - Phone:717-944-0491
Practice Address - Fax:717-944-1436
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT190308208600000X
PAMD443128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102612365Medicaid
PA102612365Medicaid