MEDICARE: ROSHANI NARENDRAKUMAR PATEL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	MA064167	PA

General Provider Information

NPI Number	:	1013625912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSHANI NARENDRAKUMAR PATEL PA-C

Provider Business Mailing Address
First Line	:	3509 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-4105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3509 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-4105
Country	:	US
Telephone Number	:	215-707-8484
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2022
Last Update Date	:	01/22/2026

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Directions to “ ROSHANI NARENDRAKUMAR PATEL PA-C” Practice Location

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