Healthcare Provider Details

I. General information

NPI: 1225733058
Provider Name (Legal Business Name): AVANTI PATEL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9763 ROOSEVELT BLVD
PHILADELPHIA PA
19114-1010
US

IV. Provider business mailing address

570 N 5TH ST APT 533
PHILADELPHIA PA
19123-3699
US

V. Phone/Fax

Practice location:
  • Phone: 215-676-5577
  • Fax:
Mailing address:
  • Phone: 614-935-1833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS026193
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: