Provider Demographics
NPI:1720220882
Name:PATEL, SONAL ROHIT (MSRD,LD)
Entity Type:Individual
Prefix:MRS
First Name:SONAL
Middle Name:ROHIT
Last Name:PATEL
Suffix:
Gender:F
Credentials:MSRD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14807 MILTON BROOK CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9383
Mailing Address - Country:US
Mailing Address - Phone:410-472-9364
Mailing Address - Fax:410-472-0667
Practice Address - Street 1:14807 MILTON BROOK CT
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9383
Practice Address - Country:US
Practice Address - Phone:410-472-9364
Practice Address - Fax:410-472-0667
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01203133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD78280Medicaid