Provider Demographics
NPI:1700223666
Name:PATEL, KIRITKUMAR K (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRITKUMAR
Middle Name:K
Last Name:PATEL
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 2204
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-8204
Mailing Address - Country:US
Mailing Address - Phone:301-475-8833
Mailing Address - Fax:
Practice Address - Street 1:40855 MERCHANTS LN
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3769
Practice Address - Country:US
Practice Address - Phone:301-475-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD 78139OtherUPIN
MD465661000Medicaid