Healthcare Provider Details

I. General information

NPI: 1225720865
Provider Name (Legal Business Name): DHARA RAMESH PATEL DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 TAMARACK RD STE C
NEWARK OH
43055-2303
US

IV. Provider business mailing address

1908 TAMARACK RD
NEWARK OH
43055-2303
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-2560
  • Fax: 220-564-2561
Mailing address:
  • Phone: 220-564-2560
  • Fax: 220-564-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.004253
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5951001484
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: