Provider Demographics
NPI:1497756761
Name:PATANKAR, JAYANT L (MD)
Entity Type:Individual
Prefix:
First Name:JAYANT
Middle Name:L
Last Name:PATANKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 37086
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3086
Mailing Address - Country:US
Mailing Address - Phone:240-439-8913
Mailing Address - Fax:240-439-8910
Practice Address - Street 1:400 W 7TH ST
Practice Address - Street 2:PAIN AND SUPPORTIVE SERVICES
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4506
Practice Address - Country:US
Practice Address - Phone:240-566-3031
Practice Address - Fax:240-566-7400
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0062376207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010904410009Medicaid
PAB40681Medicare UPIN
PA175104Medicare ID - Type Unspecified