Provider Demographics
NPI:1982993218
Name:BHUPENDRA R. PATEL MD PC
Entity Type:Organization
Organization Name:BHUPENDRA R. PATEL MD PC
Other - Org Name:BHUPENDRA RAMBHAI PATEL M.D. P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BHUPENDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-876-0209
Mailing Address - Street 1:512 LACKAWANNA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18433-1802
Mailing Address - Country:US
Mailing Address - Phone:570-876-0209
Mailing Address - Fax:
Practice Address - Street 1:512 LACKAWANNA AVENUE
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:PA
Practice Address - Zip Code:18433-1802
Practice Address - Country:US
Practice Address - Phone:570-876-0209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021212E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005902660001Medicaid
PA0005902660001Medicaid
PAD88080Medicare PIN