Healthcare Provider Details

I. General information

NPI: 1932763489
Provider Name (Legal Business Name): SONAM PATEL DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 RT. 73 N., LOWER LEVEL
MARLTON NJ
08053
US

IV. Provider business mailing address

301 LIPPINCOTT DRIVE, SUITE 410
MARLTON NJ
08053
US

V. Phone/Fax

Practice location:
  • Phone: 855-548-7634
  • Fax:
Mailing address:
  • Phone: 856-355-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number3177
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: