Provider Demographics
NPI:1073991923
Name:PATEL, ASMITABEN A
Entity Type:Individual
Prefix:
First Name:ASMITABEN
Middle Name:A
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 SUNLIGHT LN UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1482
Mailing Address - Country:US
Mailing Address - Phone:443-513-0777
Mailing Address - Fax:
Practice Address - Street 1:12154 BRITTINGHAM LN
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-2212
Practice Address - Country:US
Practice Address - Phone:410-651-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist