Basic Information
| Provider Information | |||||||||
| NPI: | 1548608565 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PATEL | ||||||||
| FirstName: | KUSH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2005 TECHNOLOGY PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170509413 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 2005 TECHNOLOGY PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170509413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177912620 | ||||||||
| FaxNumber: | 7177912621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2013 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD465726 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RS0010X | MD465726 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 103549391 | 05 | PA | MEDICAID |