Provider Demographics
NPI:1366678302
Name:PATEL, KANAK R (MD)
Entity Type:Individual
Prefix:
First Name:KANAK
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 64916
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4916
Mailing Address - Country:US
Mailing Address - Phone:443-481-6481
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2001 MEDICAL PARKWAY
Practice Address - Street 2:ACUTE CARE PAVILION
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3280
Practice Address - Country:US
Practice Address - Phone:443-481-1000
Practice Address - Fax:443-481-1687
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD037933207RC0200X
MDD72199207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD440074700Medicaid
97489501OtherBCBS MD
607156012OtherDEPT OF LABOR/BLACK LUNG
V8140015OtherBCBS DC
607156012OtherDEPT OF LABOR/BLACK LUNG