Provider Demographics
NPI:1164921698
Name:PATEL CHRISTO, DHARTI P
Entity Type:Individual
Prefix:
First Name:DHARTI
Middle Name:P
Last Name:PATEL CHRISTO
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 1:542 WHETSTONE GLEN ST
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3350
Mailing Address - Country:US
Mailing Address - Phone:301-275-9019
Mailing Address - Fax:
Practice Address - Street 1:8815 COLUMBIA 100 PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2361
Practice Address - Country:US
Practice Address - Phone:877-776-8502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-10
Last Update Date:2018-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-17-46374106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDRBT-17-46374OtherTRICARE, POSSIBLY OTHER INSURANCE