Provider Demographics
NPI:1801972500
Name:PATEL, MANISHA (DO)
Entity type:Individual
Prefix:
First Name:MANISHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:11490 COMMERCE PARK DR # 525
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1557
Mailing Address - Country:US
Mailing Address - Phone:703-834-6244
Mailing Address - Fax:703-834-6288
Practice Address - Street 1:1800 TOWN CENTER DRIVE
Practice Address - Street 2:SUITE 222
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-834-6244
Practice Address - Fax:703-834-6288
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VADO0102201279207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology