Provider Demographics
NPI:1669482964
Name:PATEL, PIYUSH K (MD)
Entity Type:Individual
Prefix:
First Name:PIYUSH
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19745 EXECUTIVE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2642
Mailing Address - Country:US
Mailing Address - Phone:301-946-6623
Mailing Address - Fax:301-540-9448
Practice Address - Street 1:19703 EXECUTIVE PARK CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2639
Practice Address - Country:US
Practice Address - Phone:301-946-6623
Practice Address - Fax:301-540-9448
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00056345207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401493601Medicaid
MDP00316031Medicare PIN
G01969A01Medicare PIN
MD401493601Medicaid