Healthcare Provider Details

I. General information

NPI: 1689758807
Provider Name (Legal Business Name): JITENDRA K. PATEL M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 8TH ST
PORTSMOUTH OH
45662-4265
US

IV. Provider business mailing address

723 8TH ST
PORTSMOUTH OH
45662-4265
US

V. Phone/Fax

Practice location:
  • Phone: 740-353-5306
  • Fax: 740-353-8131
Mailing address:
  • Phone: 740-353-5306
  • Fax: 740-353-8131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35069645P
License Number StateOH

VIII. Authorized Official

Name: DR. JITENDRA K PATEL
Title or Position: PRESIDENT
Credential: M.D
Phone: 740-353-5306