MEDICARE: DHARA PATEL PHYSICIAN ASSISTANT

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

General Provider Information

NPI Number	:	1366237976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DHARA PATEL PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	PO BOX 72674
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44192-0002
Country	:	US
Telephone Number	:	216-281-0872
Fax Number	:	216-961-5429

Provider Business Practice Location Address
First Line	:	3569 RIDGE RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-5443
Country	:	US
Telephone Number	:	216-281-0872
Fax Number	:	216-961-5429

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

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	03/02/2026

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Directions to “ DHARA PATEL PHYSICIAN ASSISTANT” Practice Location

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