Provider Demographics
NPI:1780115071
Name:PATEL, AMRITHA PANCHANATHAN (MD)
Entity type:Individual
Prefix:MRS
First Name:AMRITHA
Middle Name:PANCHANATHAN
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:AMRITHA
Other - Middle Name:KRITHIKA
Other - Last Name:PANCHANATHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1451 BELLE HAVEN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-1201
Mailing Address - Country:US
Mailing Address - Phone:703-765-6093
Mailing Address - Fax:
Practice Address - Street 1:1451 BELLE HAVEN RD STE 110
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-1201
Practice Address - Country:US
Practice Address - Phone:703-765-6093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT66582208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program