Healthcare Provider Details

I. General information

NPI: 1912060344
Provider Name (Legal Business Name): SAMEER ANILKUMAR PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COTTMAN AVE
PHILADELPHIA PA
19111-2434
US

IV. Provider business mailing address

2500 ENGLISH CREEK AVE BLDG 800
EGG HARBOR TWP NJ
08234-5549
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-6900
  • Fax: 215-728-5507
Mailing address:
  • Phone: 609-677-7700
  • Fax: 609-677-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberM4431
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD431750
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number25MA08788600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: