Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 35123903 | OH |
Y | 2080P0204X | Pediatric Emergency Doctor | 35123903 | OH |
NPI | 1235450883 |
---|---|
Provider Name | Jimisha Patel |
First Address | Newark, OH 43055 |
Second Address | Newark, OH 43055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2010 |
Last Update Date | 18/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0105233 | (05) | OH |