Provider Demographics
NPI:1851393466
Name:PATEL, CHETANKUMAR B (MD)
Entity Type:Individual
Prefix:
First Name:CHETANKUMAR
Middle Name:B
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 1:7101 GUILFORD DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-5193
Mailing Address - Country:US
Mailing Address - Phone:301-662-2775
Mailing Address - Fax:301-662-2776
Practice Address - Street 1:7101 GUILFORD DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5193
Practice Address - Country:US
Practice Address - Phone:301-662-2775
Practice Address - Fax:301-662-2776
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD64822207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0440115Medicaid
IA36448OtherWELLMARK BC/BS
MD012122300Medicaid
PA104780QGJMedicare PIN
MD012122300Medicaid
MD101M0467Medicare PIN
PAI07513Medicare UPIN
IAI12170Medicare ID - Type Unspecified