Provider Demographics
NPI:1255370383
Name:PATEL, PRAGNA BHALABHAI (MD)
Entity type:Individual
Prefix:
First Name:PRAGNA
Middle Name:BHALABHAI
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5632 ANNAPOLIS RD
Mailing Address - Street 2:SUITE # 11
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-2213
Mailing Address - Country:US
Mailing Address - Phone:301-927-2000
Mailing Address - Fax:301-927-3030
Practice Address - Street 1:5632 ANNAPOLIS RD
Practice Address - Street 2:SUITE # 11
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2213
Practice Address - Country:US
Practice Address - Phone:301-927-2000
Practice Address - Fax:301-927-3030
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD79828100Medicaid
MDD06004Medicare UPIN
070455Medicare ID - Type Unspecified