Healthcare Provider Details

I. General information

NPI: 1639156680
Provider Name (Legal Business Name): JIVANLAL M. PATEL, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2834 MAPLEVALE RD
BROOKVILLE PA
15825-2318
US

IV. Provider business mailing address

2834 MAPLEVALE RD
BROOKVILLE PA
15825-2318
US

V. Phone/Fax

Practice location:
  • Phone: 814-849-4442
  • Fax: 814-849-6388
Mailing address:
  • Phone: 814-849-4442
  • Fax: 814-849-6388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JIVANLAL M. PATEL
Title or Position: PRESIDENT
Credential: M. D.
Phone: 814-849-4442