Provider Demographics
NPI:1265722730
Name:PATEL, ISHITA (PAC)
Entity type:Individual
Prefix:
First Name:ISHITA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ISHITA
Other - Middle Name:
Other - Last Name:THAKKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:R PAC
Mailing Address - Street 1:2500 BERNVILLE RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-9453
Mailing Address - Country:US
Mailing Address - Phone:610-743-3137
Mailing Address - Fax:610-743-3143
Practice Address - Street 1:2 MERIDIAN BLVD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610
Practice Address - Country:US
Practice Address - Phone:610-743-3139
Practice Address - Fax:610-743-3143
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014672363A00000X
PAMA056136363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant