Provider Demographics
NPI:1215503107
Name:PATIDAR, RISHA (MD)
Entity type:Individual
Prefix:MISS
First Name:RISHA
Middle Name:
Last Name:PATIDAR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:BOARDMAN PRIMARY CARE
Mailing Address - Street 2:8423 MARKET STREET SUITE 101
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-729-8700
Mailing Address - Fax:330-729-8701
Practice Address - Street 1:BOARDMAN PRIMARY CARE
Practice Address - Street 2:8423 MARKET STREET SUITE 101
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-729-8700
Practice Address - Fax:330-729-8701
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2024-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC92444207Q00000X
OH57.251713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine