Healthcare Provider Details

I. General information

NPI: 1346224995
Provider Name (Legal Business Name): JITENDRA K PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 8TH ST
PORTSMOUTH OH
45662-4020
US

IV. Provider business mailing address

1735 27TH ST STE B06
PORTSMOUTH OH
45662-2681
US

V. Phone/Fax

Practice location:
  • Phone: 740-353-5306
  • Fax: 740-353-8131
Mailing address:
  • Phone: 740-356-8681
  • Fax: 740-353-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number35069645P
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35069645P
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: