Basic Information
Provider Information
NPI: 1720053465
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: RITI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7114 RIDGE AVENUE
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191283250
CountryCode: US
TelephoneNumber: 4844761000
FaxNumber: 4844769000
Practice Location
Address1: 7114 RIDGE AVENUE
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191283250
CountryCode: US
TelephoneNumber: 4844761000
FaxNumber: 4844769000
Other Information
ProviderEnumerationDate: 02/17/2006
LastUpdateDate: 06/23/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XMD065973LPAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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