Healthcare Provider Details

I. General information

NPI: 1336601814
Provider Name (Legal Business Name): NIKETU PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 01/03/2023
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 WARM SPRINGS AVE
HUNTINGDON PA
16652-2350
US

IV. Provider business mailing address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-2200
US

V. Phone/Fax

Practice location:
  • Phone: 814-643-8408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD476572
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD066998L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: