Provider Demographics
NPI:1932305133
Name:PATEL, MEGHA
Entity Type:Individual
Prefix:
First Name:MEGHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 MARSHALEE DR
Mailing Address - Street 2:PO BOX 177 SUITE 130
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5987
Mailing Address - Country:US
Mailing Address - Phone:201-214-4156
Mailing Address - Fax:
Practice Address - Street 1:14201 LAUREL PARK DR STE 102A
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5203
Practice Address - Country:US
Practice Address - Phone:410-357-6032
Practice Address - Fax:410-630-5045
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01496213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD413936OtherMEDICARE
MDBD40-0001OtherCAREFIRST
DCBD40-0001OtherCAREFIRST
DC354562OtherMEDICARE
MD040064500OtherMEDICAL ASSISTANCE