Provider Demographics
NPI:1790017317
Name:DR PATEL CLINIC
Entity Type:Organization
Organization Name:DR PATEL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANKITKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-461-7501
Mailing Address - Street 1:927 E BALTIMORE AVE STE J-K
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2749
Mailing Address - Country:US
Mailing Address - Phone:484-461-7501
Mailing Address - Fax:484-461-7503
Practice Address - Street 1:927 E BALTIMORE AVE STE J-K
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-2749
Practice Address - Country:US
Practice Address - Phone:484-461-7501
Practice Address - Fax:484-461-7503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-06
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438763207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty