Provider Demographics
NPI:1821112723
Name:PATEL, SUKETU I (MD,, DMD)
Entity Type:Individual
Prefix:DR
First Name:SUKETU
Middle Name:I
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD,, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1037
Mailing Address - Country:US
Mailing Address - Phone:301-722-3205
Mailing Address - Fax:301-722-3207
Practice Address - Street 1:1715 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1037
Practice Address - Country:US
Practice Address - Phone:301-722-3205
Practice Address - Fax:301-722-3207
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014112831223S0112X
VA01012380431223S0112X
MD136831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery