Basic Information
Provider Information
NPI: 1669093399
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: SIMMI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3600 FORBES AVENUE
Address2: FORBES TOWER-PLAZA LEVEL SUITE 140
City: PITTSBURGH
State: PA
PostalCode: 15213
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: PATHOLOGY EDUCATION OFFICE A711 SCAIFE HALL
Address2: 3550 TERRACE STREET
City: PIITSBURGH
State: PA
PostalCode: 15261
CountryCode: US
TelephoneNumber: 4126475815
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/05/2020
LastUpdateDate: 05/05/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/05/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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