MEDICARE: JWALANT R. PATEL M.D.

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	207RN0300X	Nephrology Physician	0101252613	VA
2	207RN0300X	Nephrology Physician	MD448616	PA
3	207RN0300X	Nephrology Physician	25MA09917300	NJ
4	390200000X	Student in an Organized Health Care Education/Training Program	BP1-0031847	TX
5	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912168865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JWALANT R. PATEL M.D.

Provider Business Mailing Address
First Line	:	1619 N 9TH ST
Second Line	:	SUITE 2A
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-6501
Country	:	US
Telephone Number	:	610-628-7920
Fax Number	:	610-821-2853

Provider Business Practice Location Address
First Line	:	1619 N 9TH ST
Second Line	:	SUITE 2A
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-6501
Country	:	US
Telephone Number	:	610-628-7920
Fax Number	:	610-821-2853

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

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	08/31/2016

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