Basic Information
| Provider Information | |||||||||
| NPI: | 1033420419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | TUSHAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 MACK BLVD FL 4 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181035622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705016368 | ||||||||
| FaxNumber: | 5705014754 | ||||||||
| Practice Location | |||||||||
| Address1: | 2838 ROUTE 611 | ||||||||
| Address2: | |||||||||
| City: | TANNERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183727923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704763336 | ||||||||
| FaxNumber: | 5708397210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2010 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 16488 | NH | N | Allopathic & Osteopathic Physicians | General Practice | 207R00000X | MD477991 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | 4301097238 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.