Provider Demographics
NPI:1528370152
Name:PATEL, MALLIKA S (OD)
Entity Type:Individual
Prefix:DR
First Name:MALLIKA
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 NICOSH CIR
Mailing Address - Street 2:UNIT #2403
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1235
Mailing Address - Country:US
Mailing Address - Phone:540-250-6674
Mailing Address - Fax:
Practice Address - Street 1:4301 WISCONSIN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2160
Practice Address - Country:US
Practice Address - Phone:202-237-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2213152W00000X
VA0618001972152W00000X
DCOP1000202152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist