Provider Demographics
NPI:1679246540
Name:PRAFULLKUMAR PATEL, MD LLC
Entity Type:Organization
Organization Name:PRAFULLKUMAR PATEL, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRAFULLKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-789-1469
Mailing Address - Street 1:4600 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21225-2753
Mailing Address - Country:US
Mailing Address - Phone:443-538-3633
Mailing Address - Fax:410-789-2826
Practice Address - Street 1:4600 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-2753
Practice Address - Country:US
Practice Address - Phone:443-538-3633
Practice Address - Fax:410-789-2826
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRAFULLKUMAR PATEL, MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty