Provider Demographics
NPI:1841469723
Name:RAFIQ PATEL M D P A
Entity type:Organization
Organization Name:RAFIQ PATEL M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFIQ
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-679-5800
Mailing Address - Street 1:1952 PULASKI HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040
Mailing Address - Country:US
Mailing Address - Phone:410-679-5800
Mailing Address - Fax:410-679-2340
Practice Address - Street 1:1952 PULASKI HIGHWAY
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040
Practice Address - Country:US
Practice Address - Phone:410-679-5800
Practice Address - Fax:410-679-2340
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAFIQ PATEL M D P A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-26
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018629208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS903Medicare PIN