Provider Demographics
NPI:1790097350
Name:SAMPAT, KAPIL M (DO)
Entity Type:Individual
Prefix:DR
First Name:KAPIL
Middle Name:M
Last Name:SAMPAT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:901 DULANEY VALLEY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2600
Mailing Address - Country:US
Mailing Address - Phone:410-337-4500
Mailing Address - Fax:410-847-9240
Practice Address - Street 1:901 DULANEY VALLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2600
Practice Address - Country:US
Practice Address - Phone:410-337-4500
Practice Address - Fax:410-847-9240
Is Sole Proprietor?:No
Enumeration Date:2010-07-11
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102202807207W00000X
PAOT012730207W00000X
MDH71947207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0433951 00Medicaid
DC65083800Medicaid
VAVV2374AMedicare PIN
DC65083800Medicaid
PA231355135Medicare PIN
DC223145ZA9WMedicare PIN