Provider Demographics
NPI:1710380340
Name:PATEL, KETANKUMAR DIPAKKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KETANKUMAR
Middle Name:DIPAKKUMAR
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KETAN
Other - Middle Name:DIPAKKUMAR
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:735 NORMAN DR STE 3
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7559
Mailing Address - Country:US
Mailing Address - Phone:717-270-7908
Mailing Address - Fax:
Practice Address - Street 1:735 NORMAN DR STE 3
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7559
Practice Address - Country:US
Practice Address - Phone:717-270-7908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD470844208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty