1720593486 NPI number — CHANDRESH PATEL, MDPC

Table of content: (NPI 1720593486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720593486 NPI number — CHANDRESH PATEL, MDPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHANDRESH PATEL, MDPC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1720593486
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1524 POWNAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YARDLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19067-2758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-499-4007
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
308 FLORAL VALE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YARDLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19067-5525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-634-5864
Provider Business Practice Location Address Fax Number:
267-239-8005
Provider Enumeration Date:
12/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
CHANDRESH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
215-499-4007

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD425068 , 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: 1641433 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1760873 . This is a "HIGHMARK BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 16077 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2425425000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30029886 . This is a "KEYSTONE FIRST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7504637 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101695597000 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1468797 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 14533 . This is a "CIGNA HEALTH SPRING" identifier . This identifiers is of the category "OTHER".




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