Provider Demographics
NPI:1932302551
Name:PATEL, SAMIP S (MD)
Entity Type:Individual
Prefix:
First Name:SAMIP
Middle Name:S
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:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:443-481-6467
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2002 MEDICAL PARKWAY
Practice Address - Street 2:SUITE 430
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3263
Practice Address - Country:US
Practice Address - Phone:443-481-1940
Practice Address - Fax:443-481-1941
Is Sole Proprietor?:No
Enumeration Date:2007-06-10
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD721712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD052967200Medicaid
MD052967200Medicaid
MDP01097528Medicare PIN