Basic Information
| Provider Information | |||||||||
| NPI: | 1417169541 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | VIRAL | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1025 W HARRISBURG PIKE | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170574848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179440491 | ||||||||
| FaxNumber: | 7179441436 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 W HARRISBURG PIKE | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170574848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179440491 | ||||||||
| FaxNumber: | 7179441436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 01/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MT190308 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 207Q00000X | MD443128 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102612365 | 05 | PA | MEDICAID |