Provider Demographics
NPI:1104372325
Name:PATEL, GRISHMA JAYESH (PA-C)
Entity Type:Individual
Prefix:
First Name:GRISHMA
Middle Name:JAYESH
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1050 KEY PKWY
Mailing Address - Street 2:STE 103
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4053
Mailing Address - Country:US
Mailing Address - Phone:240-629-3926
Mailing Address - Fax:
Practice Address - Street 1:1050 KEY PKWY
Practice Address - Street 2:STE 103
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4053
Practice Address - Country:US
Practice Address - Phone:240-629-3926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant