Provider Demographics
NPI:1417225277
Name:PATEL, PRAVINKUMAR P (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAVINKUMAR
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 1:3800 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3380
Mailing Address - Country:US
Mailing Address - Phone:814-580-9696
Mailing Address - Fax:814-520-6938
Practice Address - Street 1:3800 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3380
Practice Address - Country:US
Practice Address - Phone:814-580-9696
Practice Address - Fax:814-520-6938
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037051L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA517995NLYMedicare PIN