Healthcare Provider Details

I. General information

NPI: 1467039818
Provider Name (Legal Business Name): TANVI PATEL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 CARNEGIE BLVD
MALVERN PA
19355-8519
US

IV. Provider business mailing address

401 HARVARD AVE
SOUTH PLAINFIELD NJ
07080-3933
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-6755
  • Fax:
Mailing address:
  • Phone: 973-518-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA062458
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: