Provider Demographics
NPI:1538474234
Name:KUMAR PATEL MD LLC
Entity Type:Organization
Organization Name:KUMAR PATEL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-224-5440
Mailing Address - Street 1:301 FIFTH AVE #100
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084
Mailing Address - Country:US
Mailing Address - Phone:724-224-5440
Mailing Address - Fax:724-904-7634
Practice Address - Street 1:301 FIFTH AVE #100
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084
Practice Address - Country:US
Practice Address - Phone:724-224-5440
Practice Address - Fax:724-904-7634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD07433OL207K00000X
WV20636207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810019244Medicaid
WV3810019244Medicaid
PA063267002Medicare PIN