Provider Demographics
NPI:1649477415
Name:PATEL, INDUBHAI MANIBHAI (MD)
Entity type:Individual
Prefix:DR
First Name:INDUBHAI
Middle Name:MANIBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:39 WATERMAN DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-9629
Mailing Address - Country:US
Mailing Address - Phone:570-793-4443
Mailing Address - Fax:570-819-5176
Practice Address - Street 1:1111 E END BLVD
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:PLAINS TWP
Practice Address - State:PA
Practice Address - Zip Code:18702-7923
Practice Address - Country:US
Practice Address - Phone:570-824-3521
Practice Address - Fax:570-819-5176
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD456684207R00000X
NJ25MA08233800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine