Healthcare Provider Details

I. General information

NPI: 1427124585
Provider Name (Legal Business Name): MINABEN DILIPKUMAR PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 MCNAIR ST
HAZLETON PA
18201-2275
US

IV. Provider business mailing address

851 MCNAIR ST
HAZLETON PA
18201-2275
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-5611
  • Fax: 570-459-5612
Mailing address:
  • Phone: 570-459-5611
  • Fax: 570-459-5612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD063316L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: