Provider Demographics
NPI:1467732255
Name:PATEL, KRUTIBEN V (PA-C)
Entity Type:Individual
Prefix:
First Name:KRUTIBEN
Middle Name:V
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9811 MALLARD DR STE 118
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3180
Mailing Address - Country:US
Mailing Address - Phone:301-497-9490
Mailing Address - Fax:
Practice Address - Street 1:9811 MALLARD DR STE 118
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3180
Practice Address - Country:US
Practice Address - Phone:301-497-9490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004470363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant