1285619023 NPI number — DR. PURSHOTTAM N PATEL MD

Table of content: DR. PURSHOTTAM N PATEL MD (NPI 1285619023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285619023 NPI number — DR. PURSHOTTAM N PATEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
PURSHOTTAM
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285619023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1214A LINE ST
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
SUNBURY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17801-1604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-286-0330
Provider Business Mailing Address Fax Number:
570-286-5302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1214A LINE ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
SUNBURY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17801-1604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-286-0330
Provider Business Practice Location Address Fax Number:
570-286-5302
Provider Enumeration Date:
12/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  MD037501L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0006789640001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000991683 . This is a "KEYSTME" identifier . This identifiers is of the category "OTHER".
  • Identifier: 46415 . This is a "BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7991683 . This is a "GATEWAY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01077301 . This is a "CAPITAL" identifier . This identifiers is of the category "OTHER".




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