Healthcare Provider Details

I. General information

NPI: 1609876010
Provider Name (Legal Business Name): DILIPKUMAR J. PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/30/2008
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: 570-454-7499
  • Fax: 570-454-7499
Mailing address:
  • Phone: 570-454-7499
  • Fax: 570-454-7499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD041906L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0012908090004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: