Healthcare Provider Details

I. General information

NPI: 1699290775
Provider Name (Legal Business Name): ASHISHKUMAR RANCHHODBHAI PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 07/05/2021
Certification Date: 07/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HOSPITAL AVE STE 311
DU BOIS PA
15801-1465
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-6200
  • Fax: 814-375-6452
Mailing address:
  • Phone: 814-375-4200
  • Fax: 814-375-4232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD465993
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number207XP3100X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: