MEDICARE: KEVAL PATEL DO

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	OT018281	PA
2	207Q00000X	Family Medicine Physician	OS020301	PA

General Provider Information

NPI Number	:	1871087452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVAL PATEL DO

Provider Business Mailing Address
First Line	:	101 E OLNEY AVE STE 400
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-2470
Country	:	US
Telephone Number	:	215-456-1825
Fax Number	:	215-456-5926

Provider Business Practice Location Address
First Line	:	9880 BUSTLETON AVE STE 301
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-2144
Country	:	US
Telephone Number	:	215-827-1666
Fax Number	:	215-827-1555

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

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	08/23/2021

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Directions to “ KEVAL PATEL DO” Practice Location

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