Provider Demographics
NPI:1932412780
Name:PATEL, DHRUVI N (OD)
Entity Type:Individual
Prefix:MISS
First Name:DHRUVI
Middle Name:N
Last Name:PATEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17213 COLE ROAD
Mailing Address - Street 2:STE 17233
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740
Mailing Address - Country:US
Mailing Address - Phone:240-329-4699
Mailing Address - Fax:
Practice Address - Street 1:17213 COLE RD
Practice Address - Street 2:STE 17233
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6981
Practice Address - Country:US
Practice Address - Phone:240-329-4699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2194152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist