Provider Demographics
NPI:1104926153
Name:PATEL, MANOJBHAI PARASHOTTAMBHAI (MD)
Entity type:Individual
Prefix:
First Name:MANOJBHAI
Middle Name:PARASHOTTAMBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CAMERON RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9551
Mailing Address - Country:US
Mailing Address - Phone:724-222-5567
Mailing Address - Fax:724-222-5417
Practice Address - Street 1:300 CAMERON RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9551
Practice Address - Country:US
Practice Address - Phone:724-222-5567
Practice Address - Fax:724-222-5417
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028645E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009719140009Medicaid
PA0009719140009Medicaid
PAC32796Medicare UPIN