Healthcare Provider Details

I. General information

NPI: 1679773006
Provider Name (Legal Business Name): RISHIN A PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE SUITE 233
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

1030 KINGS HWY N STE 200
CHERRY HILL NJ
08034-1907
US

V. Phone/Fax

Practice location:
  • Phone: 484-458-1000
  • Fax: 610-642-2036
Mailing address:
  • Phone: 888-985-2727
  • Fax: 856-779-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD440188
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MA09034500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: