Basic Information
| Provider Information | |||||||||
| NPI: | 1366540072 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEDER | ||||||||
| FirstName: | DHRUV | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PATEL | ||||||||
| OtherFirstName: | DHRUV | ||||||||
| OtherMiddleName: | B | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1860 TOWN CENTER DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201905896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034356604 | ||||||||
| FaxNumber: | 7037876575 | ||||||||
| Practice Location | |||||||||
| Address1: | 1860 TOWN CENTER DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201905896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034356604 | ||||||||
| FaxNumber: | 7037876575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/31/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | 45892 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207X00000X | 45892 | CO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0801X | 45892 | CO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
ID Information
| ID | Type | State | Issuer | Description | 0101243633 | 01 | VA | VIRGINIA LICENSE | OTHER |