Provider Demographics
NPI:1235325739
Name:PATEL, HIMATI PARAG (MD)
Entity Type:Individual
Prefix:DR
First Name:HIMATI
Middle Name:PARAG
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HIMATI
Other - Middle Name:KIRIT
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-7605
Mailing Address - Fax:410-328-7607
Practice Address - Street 1:22 S. GREENE STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-7605
Practice Address - Fax:410-328-7607
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045369207R00000X, 208M00000X
NJ25MA08352500207R00000X
MDD74682207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD367102000Medicaid
MDS062-0490OtherCAREFIRST BC/BS
NJ0172448Medicaid
NJ131913BB4Medicare PIN
NJ0172448Medicaid