MEDICARE: KANAN A PATEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	AG11250035	PA

General Provider Information

NPI Number	:	1588528236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANAN A PATEL

Provider Business Mailing Address
First Line	:	412 N FRONT ST UNIT 4
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 N FRONT ST UNIT 4
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-0001
Country	:	US
Telephone Number	:	732-397-7939
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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