MEDICARE: JIGNESH PATEL

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208M00000X	Hospitalist Physician	MD461371	PA

General Provider Information

NPI Number	:	1114327988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIGNESH PATEL

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-4903
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 EAST MOUNTAIN BLVD.
Second Line	:
City	:	WILKES-BARRE
State	:	PA
Zip	:	18711-3539
Country	:	US
Telephone Number	:	570-808-7399
Fax Number	:

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

Provider Enumeration Date	:	08/29/2014
Last Update Date	:	07/21/2022

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Directions to “ JIGNESH PATEL ” Practice Location

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