Healthcare Provider Details

I. General information

NPI: 1386200509
Provider Name (Legal Business Name): PRIYANSHI PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 E MAIN ST
NEWARK OH
43055-6516
US

IV. Provider business mailing address

399 E MAIN ST
NEWARK OH
43055-6516
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-1840
  • Fax: 220-564-1841
Mailing address:
  • Phone: 220-564-1840
  • Fax: 220-564-1841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.249960
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: