Provider Demographics
NPI:1083205983
Name:PATEL, DIPAL ASHOK
Entity Type:Individual
Prefix:
First Name:DIPAL
Middle Name:ASHOK
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 WEST RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-3030
Mailing Address - Country:US
Mailing Address - Phone:732-423-3241
Mailing Address - Fax:
Practice Address - Street 1:910 WEST RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-3030
Practice Address - Country:US
Practice Address - Phone:443-736-4662
Practice Address - Fax:443-735-4668
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD022346800Medicaid