Provider Demographics
NPI:1548573405
Name:PATEL, NIKUNJ PRAFULBHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:NIKUNJ
Middle Name:PRAFULBHAI
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 1:300 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2297
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331
Practice Address - Country:US
Practice Address - Phone:717-316-3711
Practice Address - Fax:717-316-3049
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24128207R00000X
PAMD453538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102986599Medicaid
WVP00938053OtherMEDICARE RR
WV3810018933Medicaid
WV4304711Medicare PIN
WVP00938053OtherMEDICARE RR