Provider Demographics
NPI:1295737914
Name:PATEL, KANAIYALAL (MD)
Entity type:Individual
Prefix:
First Name:KANAIYALAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KANU
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7235 HANOVER PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3601
Mailing Address - Country:US
Mailing Address - Phone:301-441-3122
Mailing Address - Fax:301-441-3124
Practice Address - Street 1:7231 HANOVER PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2027
Practice Address - Country:US
Practice Address - Phone:301-441-3122
Practice Address - Fax:301-441-3124
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0021799207Y00000X, 207YS0012X
MDD21799174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD255251500Medicaid
MD414995Medicare PIN
MD6490680001Medicare NSC
MDC88823Medicare UPIN