Provider Demographics
NPI:1356903744
Name:PATEL, KRUPA (DPM)
Entity type:Individual
Prefix:
First Name:KRUPA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HAMILTON HEALTH CENTER
Mailing Address - Street 2:110 S 17TH STREET
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1123
Mailing Address - Country:US
Mailing Address - Phone:717-232-9971
Mailing Address - Fax:717-920-3039
Practice Address - Street 1:HAMILTON HEALTH CENTER
Practice Address - Street 2:110 S 17TH STREET
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1123
Practice Address - Country:US
Practice Address - Phone:717-232-9971
Practice Address - Fax:717-920-3039
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC007025213ES0103X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103713219Medicaid