Provider Demographics
NPI:1720198393
Name:PATEL, KUMAR R (MD)
Entity Type:Individual
Prefix:
First Name:KUMAR
Middle Name:R
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 1:301 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084-1861
Mailing Address - Country:US
Mailing Address - Phone:724-224-5440
Mailing Address - Fax:724-904-7634
Practice Address - Street 1:301 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-1861
Practice Address - Country:US
Practice Address - Phone:724-224-5440
Practice Address - Fax:724-904-7634
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20636207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1840069000Medicaid
OH2272222Medicaid
OH4051572Medicare PIN
PA194767Medicare PIN
H45019Medicare UPIN
WV1840069000Medicaid