Provider Demographics
NPI:1912168865
Name:PATEL, JWALANT R (MD)
Entity type:Individual
Prefix:
First Name:JWALANT
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1619 N 9TH ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-6501
Mailing Address - Country:US
Mailing Address - Phone:610-628-7920
Mailing Address - Fax:610-821-2853
Practice Address - Street 1:1619 N 9TH ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-6501
Practice Address - Country:US
Practice Address - Phone:610-628-7920
Practice Address - Fax:610-821-2853
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2016-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101252613207RN0300X
PAMD448616207RN0300X
NJ25MA09917300207RN0300X
TXBP1-0031847390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1912168865Medicaid