Provider Demographics
NPI:1710959630
Name:PATEL, KANCHAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:KANCHAN
Middle Name:S
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 1:3312 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-2418
Practice Address - Country:US
Practice Address - Phone:724-658-1765
Practice Address - Fax:724-658-3703
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038537L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
168195OtherHIGHMARK B/C AND B/S
30940OtherHEALTH ASSURANCE
464927OtherAETNA US HEALTHCARE
PA0982730Medicaid
207926OtherUPMC
P011038OtherCHAMPUS
1022554OtherGATEWAY
30940OtherHEALTH AMERICA
001996OtherAETNA
30940OtherHEALTH AMERICA
PA168195Medicare ID - Type Unspecified