Provider Demographics
NPI:1750302154
Name:PATEL, PRAFULLKUMAR GORDHAN (MD)
Entity Type:Individual
Prefix:
First Name:PRAFULLKUMAR
Middle Name:GORDHAN
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 1:4600 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:410-789-1469
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:410-789-1469
Practice Address - Fax:410-789-2826
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD37111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD547481700Medicaid
E18183Medicare UPIN
MD547481700Medicaid