Basic Information
| Provider Information | |||||||||
| NPI: | 1255521290 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRIVEDI | ||||||||
| FirstName: | POORVI | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PATEL | ||||||||
| OtherFirstName: | POORVI | ||||||||
| OtherMiddleName: | V. | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3900 WOODLAND AVE | ||||||||
| Address2: | PHILADELPHIA VETERANS ADMINISTRATION MEDICAL CENTER | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158235800 | ||||||||
| FaxNumber: | 2158234411 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 WOODLAND AVE | ||||||||
| Address2: | PHILADELPHIA VETERANS ADMINISTRATION MEDICAL CENTER | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158235800 | ||||||||
| FaxNumber: | 2158234411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2007 | ||||||||
| LastUpdateDate: | 05/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MB08295700 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.