Healthcare Provider Details

I. General information

NPI: 1104984400
Provider Name (Legal Business Name): JAYKUMAR C PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BATH RD SUITE 508
BRISTOL PA
19007-3101
US

IV. Provider business mailing address

9 BRIGHTON PL
NEWTOWN PA
18940-1171
US

V. Phone/Fax

Practice location:
  • Phone: 215-785-9890
  • Fax: 215-785-9987
Mailing address:
  • Phone: 215-785-9890
  • Fax: 215-785-9987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberMD031132E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD031132E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberMD031132E
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD031132E
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberMD031132E
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD031132E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: