Healthcare Provider Details

I. General information

NPI: 1063501203
Provider Name (Legal Business Name): PRAGNA P PATEL, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 N. BETHLEHEM PIKE SUITE I
SPRING HOUSE PA
19477
US

IV. Provider business mailing address

PO BOX 905
SPRING HOUSE PA
19477-0905
US

V. Phone/Fax

Practice location:
  • Phone: 215-896-4023
  • Fax: 215-540-5598
Mailing address:
  • Phone: 215-896-4023
  • Fax: 215-540-5598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD051040L
License Number StatePA

VIII. Authorized Official

Name: DR. PRAGNA P PATEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 215-896-4023