Provider Demographics
NPI:1649216466
Name:PATEL, BHUPENDRA (MD)
Entity Type:Individual
Prefix:
First Name:BHUPENDRA
Middle Name:
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 1:2872 TURNPIKE ST
Mailing Address - Street 2:
Mailing Address - City:SUSQUEHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18847-2771
Mailing Address - Country:US
Mailing Address - Phone:570-853-3135
Mailing Address - Fax:570-853-3008
Practice Address - Street 1:2872 TURNPIKE ST
Practice Address - Street 2:
Practice Address - City:SUSQUEHANNA
Practice Address - State:PA
Practice Address - Zip Code:18847-2771
Practice Address - Country:US
Practice Address - Phone:570-853-3135
Practice Address - Fax:570-853-3008
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033103E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007810Medicaid
PA145687Medicare ID - Type Unspecified
PA1007810Medicaid