Provider Demographics
NPI:1730185950
Name:PATEL, MUKESH A (MD)
Entity type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19076-1107
Mailing Address - Country:US
Mailing Address - Phone:610-532-5343
Mailing Address - Fax:610-532-1302
Practice Address - Street 1:1421 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:PA
Practice Address - Zip Code:19076-1107
Practice Address - Country:US
Practice Address - Phone:610-532-5343
Practice Address - Fax:610-532-1302
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2021-04-23
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
PAMD038589L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00939603Medicaid
PAD71617Medicare UPIN
PA00939603Medicaid