Provider Demographics
NPI:1518173079
Name:PATEL, NISHA RAMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NISHA
Middle Name:RAMAN
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12110 SUNSET HILLS RD
Mailing Address - Street 2:SUITE C50
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5852
Mailing Address - Country:US
Mailing Address - Phone:703-834-9777
Mailing Address - Fax:703-834-8187
Practice Address - Street 1:12110 SUNSET HILLS RD
Practice Address - Street 2:SUITE C50
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5852
Practice Address - Country:US
Practice Address - Phone:703-834-9777
Practice Address - Fax:703-834-8187
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241432207W00000X
NY240173207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA022205J82Medicare PIN