Healthcare Provider Details

I. General information

NPI: 1467443457
Provider Name (Legal Business Name): P D PATEL MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 HARDIN LN SUITE#A
SOMERSET KY
42503-3800
US

IV. Provider business mailing address

104 HARDIN LN SUITE#A
SOMERSET KY
42503-3800
US

V. Phone/Fax

Practice location:
  • Phone: 606-678-8323
  • Fax: 606-451-0133
Mailing address:
  • Phone: 606-678-8323
  • Fax: 606-451-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberKY20046
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberKY20046
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateKY

VIII. Authorized Official

Name: DR. PIYUSH D PATEL
Title or Position: ADMINISTRATOR
Credential: M.D.
Phone: 606-678-8323