Healthcare Provider Details

I. General information

NPI: 1669480331
Provider Name (Legal Business Name): JENNIFER D PATEL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 LANSDOWNE AVE SUITE 201
DARBY PA
19023-1333
US

IV. Provider business mailing address

3131 WALNUT ST UNIT #630
PHILADELPHIA PA
19104-3415
US

V. Phone/Fax

Practice location:
  • Phone: 610-534-6230
  • Fax: 610-534-6166
Mailing address:
  • Phone: 347-526-7197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number228141
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberOS014386
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: