Provider Demographics
NPI:1811073422
Name:PATEL, VIKRAM MANILAL (MD)
Entity type:Individual
Prefix:DR
First Name:VIKRAM
Middle Name:MANILAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 VILLAGE GREENE BLVD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-3677
Mailing Address - Country:US
Mailing Address - Phone:215-639-2972
Mailing Address - Fax:
Practice Address - Street 1:2301 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4427
Practice Address - Country:US
Practice Address - Phone:215-291-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037437207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1280437Medicaid
PAP00774663OtherRR MEDICARE - BUCKS
PAP00789459OtherRR MEDICARE
PA100746243 0004Medicaid
PA30060281OtherKEYSTONE MERCY
PA0739380000OtherKEYSTONE HEALTH PLAN EAST
PA544102OtherHIGHMARK BLUE SHIELD
PA30060281OtherKEYSTONE MERCY-LOWER BUCKS GROUP
PA544102OtherHIGHMARK BLUE SHIELD
PA30060281OtherKEYSTONE MERCY-LOWER BUCKS GROUP
PA100746243 0004Medicaid
PAPA544102Medicare ID - Type Unspecified