Healthcare Provider Details

I. General information

NPI: 1104454214
Provider Name (Legal Business Name): POOJA ROOPESH PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4219 GATEWAY BLVD
NEWBURGH IN
47630-7925
US

IV. Provider business mailing address

PO BOX 631767
CINCINNATI OH
45263-1767
US

V. Phone/Fax

Practice location:
  • Phone: 812-426-9545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number62233
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01100173A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: