Provider Demographics
NPI:1710048004
Name:PATEL, JAYANTI L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYANTI
Middle Name:L
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:1500 FOREST GLEN ROAD
Practice Address - Street 2:UM GROUND LEVEL
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-7803
Practice Address - Country:US
Practice Address - Phone:301-754-7361
Practice Address - Fax:301-681-7609
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD34105207R00000X
VA0101056867207R00000X
MDD0052586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
014011K92Medicare ID - Type Unspecified
G63574Medicare UPIN