Provider Demographics
NPI:1609876010
Name:PATEL, DILIPKUMAR J (MD)
Entity Type:Individual
Prefix:
First Name:DILIPKUMAR
Middle Name:J
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 1:851 MCNAIR ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-2275
Mailing Address - Country:US
Mailing Address - Phone:570-454-7499
Mailing Address - Fax:570-454-7499
Practice Address - Street 1:851 MCNAIR ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-2275
Practice Address - Country:US
Practice Address - Phone:570-454-7499
Practice Address - Fax:570-454-7499
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041906L207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012908090004Medicaid
PA728220Medicare PIN
PA0012908090004Medicaid