Healthcare Provider Details

I. General information

NPI: 1649256843
Provider Name (Legal Business Name): KAUSHIK P PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 BROWNSVILLE RD
PITTSBURGH PA
15210-4503
US

IV. Provider business mailing address

2409 BROWNSVILLE RD
PITTSBURGH PA
15210-4503
US

V. Phone/Fax

Practice location:
  • Phone: 412-886-9803
  • Fax: 412-886-1918
Mailing address:
  • Phone: 412-886-1628
  • Fax: 412-886-1643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD071045L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: