Basic Information
| Provider Information | |||||||||
| NPI: | 1275154395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | YAMINI | ||||||||
| MiddleName: | INDRAVADAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1609 SUMMIT POINTE | ||||||||
| Address2: | |||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232279657 | ||||||||
| FaxNumber: | 5703434800 | ||||||||
| Practice Location | |||||||||
| Address1: | 1609 SUMMIT POINTE | ||||||||
| Address2: | |||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232279657 | ||||||||
| FaxNumber: | 5703434800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2020 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | MT221049 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.