Provider Demographics
NPI:1215740980
Name:PATEL, NIMA (PA-C)
Entity type:Individual
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First Name:NIMA
Middle Name:
Last Name:PATEL
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Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-808-7762
Mailing Address - Fax:570-808-6128
Practice Address - Street 1:1000 E MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0001
Practice Address - Country:US
Practice Address - Phone:570-808-7762
Practice Address - Fax:570-808-6128
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOA007171363A00000X
PAMP9448627363A00000X
PAMA066387363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant