Provider Demographics
NPI:1548538739
Name:PATEL, NILAM D (PA-C)
Entity type:Individual
Prefix:
First Name:NILAM
Middle Name:D
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MORTON AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-2210
Mailing Address - Country:US
Mailing Address - Phone:610-595-6850
Mailing Address - Fax:610-595-6892
Practice Address - Street 1:8 MORTON AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-2210
Practice Address - Country:US
Practice Address - Phone:610-595-6850
Practice Address - Fax:610-595-6892
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000798363A00000X
PAMA055294363A00000X
PAOA003091363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE233614ZATAMedicare UPIN
PA309678Medicare PIN