Provider Demographics
NPI:1760611032
Name:PATEL, SAMIR (DPM)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1546 PRATT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-1923
Mailing Address - Country:US
Mailing Address - Phone:908-705-1757
Mailing Address - Fax:215-787-9398
Practice Address - Street 1:1546 PRATT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-1923
Practice Address - Country:US
Practice Address - Phone:215-533-8555
Practice Address - Fax:215-533-8656
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006131213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery