Healthcare Provider Details

I. General information

NPI: 1710380340
Provider Name (Legal Business Name): KETANKUMAR DIPAKKUMAR PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KETAN DIPAKKUMAR PATEL M.D.

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 NORMAN DR STE 3
LEBANON PA
17042-7559
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-7908
  • Fax:
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD470844
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: