MEDICARE: POONAM MAHESH PATEL DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	0103301488	VA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	SC007376	PA

General Provider Information

NPI Number	:	1457032187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POONAM MAHESH PATEL DPM

Provider Business Mailing Address
First Line	:	130 MONUMENT RD APT 337
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-1760
Country	:	US
Telephone Number	:	757-971-2065
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 RIDGE AVENUE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128
Country	:	US
Telephone Number	:	757-971-2065
Fax Number	:

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

Provider Enumeration Date	:	07/26/2023
Last Update Date	:	05/29/2026

Similar Medicare Providers

1528713088 — DANIEL WOLFF FNP, PMHNP
Practice Location Address:

561 FAIRTHORNE AVE
PHILADELPHIA, PA
19128-2412

Practice Phone: 267-338-2263
Practice Fax:

1598696486 — ALEXANDRA HATHORN
Practice Location Address:

5235 RIDGE AVE
PHILADELPHIA, PA
19128-3782

Practice Phone: 267-626-9448
Practice Fax:

1255260741 — CAROLINE NICOLE DOUGHERTY RN
Practice Location Address:

350 KRAMS AVE
PHILADELPHIA, PA
19128-4733

Practice Phone: 610-427-3718
Practice Fax:

1073443297 — MRS. SRIRAGA HARSHINI SUDEPALLI
Practice Location Address:

5800 RIDGE AVENUE, NYMC-ROXBOROGH MEMORIAL HOSPITAL , SUITE 353
PHILADELPHIA, PA
19128

Practice Phone: 215-487-4284
Practice Fax:

1932071321 — VIVIAN WAN-WAI LO PA-C
Practice Location Address:

6062 RIDGE AVE
PHILADELPHIA, PA
19128-1647

Practice Phone: 215-395-7546
Practice Fax:

1992587570 — JENNIFER RANDO MT-BC
Practice Location Address:

7707 MATTHIAS ST
PHILADELPHIA, PA
19128-3107

Practice Phone: 215-421-7983
Practice Fax:

Directions to “ POONAM MAHESH PATEL DPM” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.