Provider Demographics
NPI:1932330198
Name:PATEL, AMIT A (PA-C)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:PA-C
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 997
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-0997
Mailing Address - Country:US
Mailing Address - Phone:410-877-8661
Mailing Address - Fax:410-877-2665
Practice Address - Street 1:2012 S TOLLGATE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-5900
Practice Address - Country:US
Practice Address - Phone:410-877-8661
Practice Address - Fax:410-877-2665
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC03999363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant