Provider Demographics
NPI:1205867876
Name:PATEL, BHAVNA K (MD, FAAP)
Entity type:Individual
Prefix:
First Name:BHAVNA
Middle Name:K
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-4851
Mailing Address - Country:US
Mailing Address - Phone:856-205-1112
Mailing Address - Fax:856-205-1114
Practice Address - Street 1:2950 COLLEGE DRIVE
Practice Address - Street 2:UNIT 2 C
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360
Practice Address - Country:US
Practice Address - Phone:856-692-6000
Practice Address - Fax:856-692-0609
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06289200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22-3133751OtherTAX IDENTIFICATION NUMBER
NJ4993900Medicaid
NJ4993900Medicaid