Individual
DR. SHIVAM PATEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 E MOUNTAIN DR, WILKES BARRE, PA 18711-0027
(570) 808-7300
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
C7-0003758
DE
2085B0100X
Body Imaging Physician
MD444564
PA
2085R0202X
Diagnostic Radiology Physician
Primary
MD444564
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C7-0003758
DE ACGME TRAINING LICENCE
DE
Enumeration date
06/01/2007
Last updated
08/19/2020
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