Basic Information
| Provider Information | |||||||||
| NPI: | 1053304568 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | KANTILAL | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 NORTH SEVENTH STREET | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172673000 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 09/14/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD028392E | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 25-1716306 | 01 | PA | SOUTH CENTRAL PREFERRED | OTHER | 25-1716306 | 01 | PA | FIRST HEALTH | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | 2183091 | 01 | PA | MAMSI | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | 261422 | 01 | PA | UNISON | OTHER | 6906141 | 01 | PA | AETNA HMO | OTHER | AP2005622 | 01 | PA | DEA | OTHER | MD028392E | 01 | PA | MEDICAL LICENSE # | OTHER | 000920316 0007 | 05 | PA | MEDICAID | 25-1716306 | 01 | PA | INFORMED | OTHER | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | 50082376 | 01 | PA | CAPITAL BLUECROSS | OTHER | PA404696 | 01 | PA | HIGHMARK BLUESHIELD | OTHER | 1053304568 | 01 | PA | HEALTH AMERICA | OTHER | 050514 | 01 | PA | MEDICARE GROUP # | OTHER | 1007307260036 | 01 | PA | MEDICAID GROUP # | OTHER | 120420418 | 01 | PA | DEPT OF LABOR | OTHER | 5330051 | 01 | PA | AETNA NON-HMO | OTHER | G920-0115/85XWCU | 01 | PA | CAREFIRST | OTHER | P00683494 | 01 | PA | RAILROAD MEDICARE | OTHER |