Healthcare Provider Details

I. General information

NPI: 1114455300
Provider Name (Legal Business Name): JANISHA PATEL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 06/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD CROZER PEDIATRICS, POB 1, SUITE 205
UPLAND PA
19013
US

IV. Provider business mailing address

1 MEDICAL CENTER BLVD
CHESTER PA
19013-3902
US

V. Phone/Fax

Practice location:
  • Phone: 610-619-7410
  • Fax: 610-876-8483
Mailing address:
  • Phone: 610-447-6680
  • Fax: 610-876-8483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOT018007
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: