Provider Demographics
NPI:1528264215
Name:PATEL, JAYRAG A (MD)
Entity type:Individual
Prefix:DR
First Name:JAYRAG
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:216 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-4809
Mailing Address - Country:US
Mailing Address - Phone:215-781-2020
Mailing Address - Fax:215-788-3504
Practice Address - Street 1:601 WALNUT ST
Practice Address - Street 2:STE L30
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106
Practice Address - Country:US
Practice Address - Phone:212-925-6402
Practice Address - Fax:215-925-0262
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08472100207W00000X
NY244576207W00000X
PAMD433857207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY621B1OtherEMPIRE BLUE CROSS BLUE SHIELD
NY493579L771Medicare PIN