Provider Demographics
NPI:1023307352
Name:PATEL, PANKTI R (MD)
Entity type:Individual
Prefix:
First Name:PANKTI
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:6105 SPIRIT ST
Mailing Address - Street 2:APT 345
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3175
Mailing Address - Country:US
Mailing Address - Phone:419-351-4250
Mailing Address - Fax:
Practice Address - Street 1:125 MINEOLA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2023
Practice Address - Country:US
Practice Address - Phone:516-616-5500
Practice Address - Fax:888-502-6582
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD457365208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program