Provider Demographics
NPI:1538320601
Name:PATWA, PREMALKUMAR RAJNIBHAI (MD)
Entity Type:Individual
Prefix:
First Name:PREMALKUMAR
Middle Name:RAJNIBHAI
Last Name:PATWA
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:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:19 FORT EVANS RD NE STE C
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4487
Practice Address - Country:US
Practice Address - Phone:703-737-2110
Practice Address - Fax:703-737-2111
Is Sole Proprietor?:No
Enumeration Date:2008-06-21
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0945432084P0800X
VA01012746312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry