Provider Demographics
NPI:1972544674
Name:PATEL, SAMIR BABUBHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:BABUBHAI
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 1:1509 STONE POST CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-5818
Mailing Address - Country:US
Mailing Address - Phone:410-776-2286
Mailing Address - Fax:
Practice Address - Street 1:500 UPPER CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4324
Practice Address - Country:US
Practice Address - Phone:410-420-7630
Practice Address - Fax:410-420-7911
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62983207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408169200Medicaid
MDL355Medicare ID - Type Unspecified
MD408169200Medicaid