Provider Demographics
NPI:1952340648
Name:PATEL, SHASHANK G (MD)
Entity Type:Individual
Prefix:
First Name:SHASHANK
Middle Name:G
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHASHANK
Other - Middle Name:G
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:18121 GEORGIA AVE SUITE 103
Mailing Address - Street 2:ADVANCED INTERNAL MEDICINE PC
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832
Mailing Address - Country:US
Mailing Address - Phone:301-933-5050
Mailing Address - Fax:301-949-3262
Practice Address - Street 1:18121 GEORGIA AVE STE 103
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1437
Practice Address - Country:US
Practice Address - Phone:301-933-5050
Practice Address - Fax:301-949-3262
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD585692200Medicaid
BP7222324OtherDEA
408708Medicare PIN
MD585692200Medicaid