Basic Information
| Provider Information | |||||||||
| NPI: | 1548655863 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | NICK | ||||||||
| MiddleName: | NISHEETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4923 OGLETOWN STANTON RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026559494 | ||||||||
| FaxNumber: | 3026911478 | ||||||||
| Practice Location | |||||||||
| Address1: | 4923 OGLETOWN STANTON RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026559494 | ||||||||
| FaxNumber: | 3026911478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2015 | ||||||||
| LastUpdateDate: | 08/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207X00000X | C1-0024206 | DE | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.